Dáil Éireann díospóireacht -
Tuesday, 30 Mar 1993

Vol. 428 No. 5

Adjournment Debate. - Treatment of Alcoholism.

Mr. Ferris

Thank you for allowing me to raise this matter on the Adjournment. I also thank the Minister, Deputy Howlin, for coming in to reply in person.

Alcoholism and alcohol-related problems make a very heavy demand on our psychiatric services. Three years ago alcohol abuse accounted for 24 per cent of all admissions to health board psychiatric hospitals. In total there were 6,608 admissions to public psychiatric hospitals in 1989 and of these 2,234 were first admissions.

At the beginning of this month the Minister hosted a conference under the auspices of the Eastern Health Board and delivered an excellent address. The conference was attended by experts in this field from Ireland, the UK and mainland Europe, certain differences of opinion were evident and this is the reason I raise this matter.

In the report "Planning for the Future" it was stated that the trend in Ireland was towards greater specialisation in the management of alcohol-related problems, that this approach often involved costly in-patient care which tended to separate the treatment and management of alcohol-related problems from the community, medical and social services. The report questioned the wisdom of this approach on the grounds that there was no evidence that intensive high cost in-patient treatment was in any way superior to simple, inexpensive community-based intervention, which is much more cost effective.

I ask the Minister to consider all the options available. Each should be considered and should not be exclusive of another. We should have a national policy on the treatment of alcoholism and alcohol abuse. In the Minister's own constituency of Wexford and in mine of Tipperary, Sister Eileen Fahy of Aiseiri is giving a tremendous service in a drug free environment to people from all walks of life. Her service has been recognised by an award of Tipperary Person of the Year and by a civic reception by the chairperson and members of Tipperary South Riding County Council. She has been recognised by all the State and semi-State agencies such as Telecom Éireann, An Post, the ESB, the Garda Síochána and the prison officers. All her ideas have been used for the benefit of these major employers. She has now commissioned an independent survey by an eminent professor from one of our leading universities. I am sure this report, when completed, will confirm that there is merit in her system and that it is indeed cost effective.

I hope the Minister will avail of an early opportunity to meet people like Sister Eileen Fahy and to talk with her and the other experts in the public service with a view to approaching this major problem in a rational and structured way; this problem has been the cause of many man hours lost to industry, broken homes, crime, rape, incest and many others. Much of this comes down to the abuse of alcohol and there is a responsibility on all of us to try to deal with this problem.

Minister for Health (Mr. Howlin)

I should like to thank Deputy Ferris for raising this important issue and allowing me the opportunity to address the House on it.

The treatment of alcohol dependence in this country, as in many others, developed within the psychiatric services. Information on those treated for alcoholism is available only for those treated in psychiatric hospitals and units. In 1989, the latest year for which figures are available, there were 6,608 admissions to psychiatric hospitals and units with the diagnosis "alcohol related disorders". This number of admissions represented a rate of 186.6 per 100,000 and was the second most frequent reason for admission to our psychiatric hospitals and units. Of all admissions for alcohol related disorders, 2,234 or 29.5 per cent were first time admissions and the remainder were on their second or subsequent admission. Between 1980 and 1989 there was a slight drop in the number of admissions and admission rates per 100,000 population for alcohol related disorders. This fall is probably due to the growth of alternative treatment centres outside the psychiatric hospital.

The report of a study group on the development of the psychiatric services, "Planning for the Future" published in 1984 questioned the need for so many persons with alcohol related disorders being referred for treatment to psychiatric hospitals and units. This approach often involved costly in-patient care which tended to separate the treatment and management of alcohol related problems from community and social services. The report questioned the wisdom of this approach on the following grounds. First, there was no evidence that intensive, high cost in-patient treatment was in any way superior to community based intervention. Compared with the latter form of management, the intensive approach was not considered to be cost effective. Second, the over specialised approach to alcohol-related problems was also a separatist approach. It drew the problem away from the community and family and tended to exclude the contribution of primary medical and social services from the management of the problem. To that extent, it ran counter to the general principles of the delivery of health care which stress that help to individuals and families should be as near to their communities and homes as possible.

In accordance with World Health Organisation opinion, the report recommended that alternative services be developed for the treatment of alcohol related disorders on the following lines: Each sector or district of the psychiatric services to develop a local alcohol-drug service which would be community based, with the emphasis on out-patient treatment; each sector to have access to a small number of beds to treat patients who could not attend on a day basis because of long distances or for social reasons; the sector service to act as a resource centre for all the services and personnel concerned with alcohol abuse in the sector; one consultant psychiatrist in each catchment area of the psychiatric service to be assigned responsibility for the organisation and operation of services for persons with alcohol-related problems in the area; the psychiatric team to provide a consultation service to general practitioners and other primary care personnel concerning treatment of persons with alcohol-related problems.

A recent publication, a "Directory of Alcohol and Drugs Services in the Republic of Ireland" provides useful information on the treatment services currently available to people with alcohol related disorders.

The directory lists 74 centres where treatment is available for people with alcohol related disorders. These include the psychiatric hospitals, residential centres, day services and "halfway" houses. Thirty-three of these centres provide in-patient services, reflecting the move in the eighties and nineties from residential treatment programmes. The common denominator in the majority of treatment programmes is counselling and advice.

The concept of treatment does not fit easily with the process involved in helping a person to overcome his or her dependence on alcohol. There is no medical procedure or pill that will cure an alcoholic of his disease. The Government is particularly concerned about the problem of alcohol abuse generally and by young people in particular. I want to assure the Deputy and the House that every effort will be made in my Department to provide adequate services to cure this social problem.