Alcohol,Families and Community Alcohol Services

1
Alcohol,Families and Community Alcohol Services

• Nordan Conference,Tallinn 2008
• Marion Rackard,SRN,Addiction Counsellor,Psychother
  apist

2
Presentation

• National Drugs Strategy- Alcohol
• National NGO Survey
• Alcohol-related harm in Ireland
• Characteristics of Families
• NGO Treatment Position Paper 2008
• 1 Community Alcohol Service
• Challenges for the Future

3
National Drugs Strategy 2001-2008

• Drugs Strategy Unit
• National Drugs Strategy Team
• Interdepartmental group on drugs

• 14 local Drugs Task Forces-340 projects
• 10 Regional Drugs Task Forces- 165 projects

4
5 Pillars of the National Drug Strategy

• Supply reduction
• Prevention,Education and Awareness
• Treatment and Risk Reduction-8,760 people
  attending for methadone maintenance Jan.2008
• Rehabilitation
• Research

5
Comparison between National Policy Frameworks re
illicit Drugs and Alcohol

• National Drugs Strategy 2001-2008/Mid-Term Review
  2001-2008
• Overall Strategic Objective- To significantly
  reduce the harm caused to individuals and society
  by the misuse of drugs through a concerted focus
  on supply reduction,prevention,treatment and
  research.

• Alcohol 2 Task Force reports 2002,2004-not
  strategies
• Overall Strategic objective NONE

6
Current Role of NDST in relation to Alcohol under
the NDS

• Under 18s
• Poly-drug use

7
Comparison between current structures at a number
of levels
8
Comparison between Current Structures at a number
of Levels contd.
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Alcohol Action IrelandAlcohol in IrelandTime
for ActionSurvey of Irish Attitudes 2006

• 82 of people believe alcohol consumption levels
  a problem
• 57 concerned about someones use of alcohol
• 66 of people knew someone with a problem
• 44 have been injured,harrassed or intimidated by
  someone elses use of alcohol
• 54 of people would support an increase in
  taxation if put to harm reduction measures
• 71 support 9pm advertising ban

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Extent of Alcohol-Related Harm in Ireland

• AE- 25 alcohol-related injury(Hope A et
  al.,2005)
• 1995-2004-Alcohol-related deaths doubled to
  1,775(50 age 50-70yrs)HRB(2007)
• GP attendances -22 of drinkers in Hazardous
  zone,17 in harmful/dependent zone
• (Anderson et al.,2006)

• Self-harm 47.4 male episodes, 39.1 female
  episodes(NSRF 2005)
• Public Hospitals
• 30 of all male patients,8 of female
  patients underlyingunidentified problem (Hearne
  et al 2002)
• Number of people discharged with alcohol related
  liver disease went up by 147(HRB 2007)

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Harms- EU 125 Billion(2003)

• Harm to others
• Violence
• Drink driving
• FAS,FASD
• Youth
• Public disorder
• Social exclusion
• Neurophysiological damage
• Older people
• Cancer
• Mental Health
• Disadvantaged
• More harm

12
Parenting Styles of Problem Drinkers

• Not consistent
• Unpredictable
• Ambivalent
• CHAOTIC
• Authoritarian
• Neglectful

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Children Parents

• Children are multi-sensory
• Parents problems become childrens problems
• Children thrive in homes high in
  love,attention,routine,and low in
  tension,aggression and unpredictability

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Faculty of Substance Misuse of the Royal College
of Psychiatrists 2004

• Currently treatment of alcohol abuse and
  dependence consists of the provision of piecemeal
  outpatient services which have developed out of
  various local initiatives rather than any
  coherent or planned strategy.
• Consequently services vary in quantity and
  quality across the country.There has been
  excessive reliance on charitable and religious
  based treatment services which although
  experienced and well intentioned are patchy in
  coverage and function independently.

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Alcohol Action Ireland Position Paper on
Treatment Systems and Services, 2008

• Most services located outside Dublin are combined
  alcohol/drug
• HSE provides services at 47 locations
• Registered charities,private centres and private
  psychiatric hospitals provide services at 18
  locations
• Services are mainly community based.
• Voluntary agencies provide services for homeless
  dependent drinkers
• Non specialist services provided in some general
  hospitals.
• Centres staffed mainly by addiction counsellors
• Counselling is main form of treatment

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Community Alcohol Services,SW Dublin1991-2004

• 1991- service set-up
• 5 staff-addiction counsellorsSRNvaried
  trainings
• Catchment area- 500,000 South West Dublin
• Adequate Building in Mental Health Facility
• Accessible,responsive,equitable

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What is Treatment

• Treatment provides an opportunity to intervene
  and interrupt the psychological,social and
  biological processes which act to trap the person
  within a destructive pattern of addictive
  behaviour. (Michael Gossop 2004)

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Hazelden Model/ Motivational Interviewing,RET
Approach

• Emphasis Providing services at each phase of
  Cycle of Change(Prochaska and Declimente)
• Accessibility to Family Members
• Liaison with Family Services

• Programmes
• 4 wk alcohol education prog.
• Decision group
• Abstinence group
• Aftercare Group
• Concerned Person Group
• Individual Counselling
• Night Programmes
• Family/Couples therapy
• Long term group therapy

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Concerned Persons Programme(14)

• Treatment Access
• Alcohol Education Programme(1/2 day week in
  presence of drinkers)
• Individual Counselling sessions
• 14 weeks Group Therapy Education on Addiction
• Group Therapy addresses co-dependency,self-care,ch
  allenging situation

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Programme Results

• Awareness of Addiction
• of level of personal pain
• of impact on children
• . of personal needs and desires
• . of decreased tolerance for unacceptable
  behaviour
• .. mutual support for legal action
• decreased isolation and loneliness
• commitment to Al-Anon
• due to changed behaviours,partners opted to
  attend treatment some months later

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Challenges for the Future

• Treatment Prevention Personnel need to find
  creative ways to transfer knowledge and
  experience of harm to public
• NGOs to form alliances to impact political
  process re harm to third parties e.g road
  safety,families
• Increased liasionwork with social services
• Development of advocacy groups

• Raise profile of harm to children need for
  protection
• Media training for advocates
• Link Alcohol Policy and decrease of harm to
  others
• Remember the smoking ban and its tactics
• Raise profile of ENCARE in EU Alcohol and Health
  Forum

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Tonysolimene_at_eircom.net