A future full of hope: Crosscare annual report 2003.

Crosscare (formerly known as the Catholic Social Service Conference CSSC) have been responding to the needs of people on the margins of society since 1941. Currently they employ close to 170 staff with an annual expenditure running towards €11 million. Their range of programmes is diverse and they reach into areas of high need.This resource was contributed by The National Documentation Centre on Drug Use.

454 Users Successfully 'weaned off' Methadone

A total of 454 methadone users successfully completed treatment programmes aimed at weaning them off the heroin substitute last year - but more than 2,000 others left the state's maintenance programme during the same period for a variety of reasons, new figures have revealed. According to statistics released under the Freedom of Information Act, there were 9,760 methadone users around the country last year, with the majority in the Dublin area. However, over 2,778 clients of the methadone maintenance service left the HSE's central treatment lists during the year. A summary of the reasons reveals that in 1,268 instances, they did so after either being released or committed to prison.This resource was contributed by The National Documentation Centre on Drug Use.

A Cannabis Reader: Global Issues and Local Experiences

The EMCDDA’s cannabis monograph addresses one basic question. How can I find quality information on cannabis, amid all the bias and opinion? The monograph is divided into two volumes. The first volume centres on political, legislative, commercial and social developments relating to cannabis. Its core audience thus comprises policymakers, sociologists, historians, journalists and those involved in enforcement. The second volume is targeted at drugs professionals working in the fields of treatment, prevention and healthcare.This resource was contributed by The National Documentation Centre on Drug Use.

A Carbon Tax for Ireland

The Programme for Government 2007-2012 states that '[a]ppropriate fiscal instruments, including a carbon levy, will be phased in on a revenue-neutral basis over the lifetime of this Government.' The terms of reference of the Commission on Taxation repeats the commitment to introduce measures to further lower carbon emissions and to phase in on a revenue neutral basis appropriate fiscal measures including a carbon levy over the lifetime of the Government and invites the Commission to [i]nvestigate fiscal measures to protect and enhance the environment including the introduction of a carbon tax. This paper presents thoughts and considerations about such a carbon tax. It discusses selected design issues, and presents a preliminary impact assessment for what the authors think is a reasonable design. More specifically, It addresses ten questions: 1. Why impose a carbon tax? 2. What level should the tax be? 3. Who should be taxed? 4. What is the expected revenue? 5. What to do with the revenue? 6. What are the macro-economic implications? 7. What are the effects on emissions? 8. What are the effects on income distribution? 9. How to tax internationally traded goods and services? 10. What about fuel tourism? On some of these questions, it presents arguments and evidence. Other questions call for further research. Aspects of some questions can only be answered by the Dail �ireann.This resource was contributed by The National Documentation Centre on Drug Use.

A Comparative Study of Healthcare Professionals' Attitudes towards Clients with Dual Diagnosis.

The aim of this study was to explore the attitudes of Healthcare Professionals who work in the Substance Misuse Services compared to Healthcare Professionals who work in the Acute Mental Health Services towards clients with a dual diagnosis. A Likert type questionnaire was carried out between the two services, (n=45) from Substance Misuse and (n+54) from Mental Health Services of the multidiscipline teams. The results showed that there was a significant difference between the attitudes of the Healthcare Professionals in both Services. The Healthcare Professionals from the Substance Misuse Services displayed a more positive attitude towards clients with duel diagnosis, than professionals from the Acute Mental Health Services. These negative attitudes may affect the quality of care given to clients with a dual diagnosis. Healthcare Professionals need more knowledge and understanding about effective treatment for this client group. It is important that through collaboration from both services the care and treatment for clients with a dual diagnosis can be at optimal level.This resource was contributed by The National Documentation Centre on Drug Use.

A Ghost in Daylight: Making Sense of Substance Misuse

The inability to deal with substance misuse is a universal human problem. No country has discovered a failsafe way of tackling it. In Ireland there is an annual public outcry about an ever-deepening drinking culture but once the outcry is over the problem subsides below consciousness. Strategies are created and launched and quickly forgotten. Everybody is aware of the problem in their own family or neighbourhood and everybody has their own opinion on causes and remedies. Why then does nothing seem to work? After demonstrating the shortcomings of previous models of addiction, Jack Houlahan identifies a pattern that all human use of substances has in common. In A Ghost in Daylight, the general reader will find many popular stereotypes re-examined in a way that will illuminate their own experience; the specialist addiction worker or researcher will find reason to challenge first principles; a new approach to counselling and advice work is suggested; the policy-maker will find a firm foundation for what will be the first attempt at an integrated policy for dealing with the range of issues we group under the title 'substance misuse'.This resource was contributed by The National Documentation Centre on Drug Use.

A Grounded Theory Model of the Counselling Referral Process in Primary Care Methadone Treatment in Ireland.

In terms of the treatment of illicit drug abuse, methadone maintenance is a well researched and widely applied systematic response. The approach to primary care methadone treatment in Ireland is based on the methadone protocol. Primary care plays a central role in the delivery of methadone treatment. Beginning with a view that a system evolves within the constraints and influencing factors of its context, the aim of this thesis is to model the process that has developed by which patients on primary care methadone treatment are referred to counselling. It investigates the role primary care practitioners perceive they have in relation to managing the psychosocial aspects of the methadone patient's treatment regime. It analyzes individual medical practitioner counselling referral mechanisms to determine what common processes operate across different practitioners. It identifies the factors that influence the use of counselling on primary care methadone programmes and structures these in a cause/effect model. This research used interviews and documentary analysis to acquire grounded data. The sample consisted primarily of medical practitioners involved in the delivery of methadone programmes. Others closely involved in the implementation of drug treatment in the primary care context made up the balance of interviewees. The study used a grounded theory methodology to induce the process that was latent in the grounded data. Concepts emerging were grouped under the headings of referral factors, decision making factors and factors related to the unique positioning of primary care at the interface between medicine and society. The core finding was that, in primary care in Ireland, there is no psychological model to complement the pharmacological intervention of methadone substitution. The findings from this study offer insight into the factors at work and their impacts, in the context of the use of counselling in primary care methadone treatment. The study suggests a possible direction for further evolution of opiate abuse treatment in Ireland which would transform it from a harm reduction to a holistic patient centric paradigm.This resource was contributed by The National Documentation Centre on Drug Use.

A Process Analysis of Males and Females who Attended a Community Based Addiction Treatment Service: Towards an Expanded Paradigm

A process analysis was conducted in a community - based treatment programme for alcohol abuse. The aims of the study were: to evaluate assessment instruments and measures; to measure change following treatment; to monitor gender differences; to assess the importance of early and current relationships; and to evaluate the effects of therapists. Subjects (n=145, males 83/females 62) completed a semi-structured interview schedule, Severity of Alcohol Dependency Questionnaire (SADQ), Short Alcohol Dependence Data Questionnaire (SADD); General Health Questionnaire (GHQ 12), and Alcohol Problems Questionnaire (APQ). A further three non-standardised self-rated measures were devised by the author. Included was the opportunity to obtain qualitative data. Follow up data was collected at 3, 9 and 15 months following first assessment. The SADD, APQ and consumption measures using detailed drink diaries proved the most relevant assessment measures. Following treatment, there was significant reduction in clients' dependency levels at 3 months, maintained through 9 and 15 months. Key client-rated changes were progress in reducing consumption and alcohol problems leading to a better quality of life and health. Qualitative data augmented these quantitative results. Psychological and acquired cognitive behavioural skills emerged as the main reasons for positive change and the treatment programme was found to have played a significant role in their acquisition. It appears that addressing marital problems can lead to a reduction in alcohol dependency levels. Gender analysis showed that males and females were similar in demographic characteristics, alcohol history details and dependence levels. It was concluded that the differences found did not necessitate different treatment programmes for women. Early family relationships were more problematic for females. Therapist performance varied and that variance was reflected in their clients' outcomes.This resource was contributed by The National Documentation Centre on Drug Use.

A Review of Harm Reduction Approaches in Ireland and Evidence from the International Literature

This report examines international literature on harm reduction and also presents primary research in health services in Ireland on approaches to harm reduction. The aim of harm reduction efforts is to minimise the risks stemming from shared use of drug-use paraphernalia, such as needle exchange programmes. One of the criticisms of Irish drug services is that the restricted opening hours and limited number of exchange services may contribute to continued sharing of needles among drug users. The report points out that other non-injecting paraphernalia such as spoons are also associated with the risk of contracting diseases, yet services do not as yet focus on them. The report notes that specific risk factors that contribute to risky drug practices include youth, a shorter injecting history, confinement to prison, homelessness and being involved in a sexual relationship with another intravenous drug user. The report suggests that harm reduction practices can be introduced into a prison population without a subsequent increase in drug consumption rates. The provision of consumption rooms and the prescription of heroin are also discussed, with the report noting that legislation would have to altered to implement these new strategies.This resource was contributed by The National Documentation Centre on Drug Use.

A Sociological Analysis of Contemporary Irish Social Drinking Patterns

This thesis seeks to provide an understanding of contemporary Irish social drinking patterns by conducting a detailed analysis of the evolving sociological theories of alcohol consumption in Ireland. ‘Alcohol is a social drug which, to this day, evokes the divisive moral qualities that originated, or at least were solidified, in the last century with the birth of temperance movements’ (Cassidy, 1997:175). The temperance movement in Ireland under Father Mathew, a legacy which still reverberates in Irish society, served to further ingrain the ‘image of the whisky drinking Irishman’ (Ibid: 17). This is seen in such work as Stivers (1976) who uses sociological labelling theory to provide verification of a deviant Irish status, biologically, socially and culturally predisposed to alcohol. The author argues that these temperance movements sought to remove the linkages of alcohol and “Irishness” but this quasi-stigmatisation process created a “self-fulfilling prophecy”, which further abetted the legitimisation of alcohol within cultural spheres. The tourism industry, in connection with drink manufacturers, has had a monumental role in alcohol’s contemporary position within the upper echelons of Irish culture and heritage. Their hand in the commodification of “Stage Irishy”, seen as “craic”, has further entrenched the links between consumption of alcohol and the consumption of Irish Identity “McGovern, 2002). Furthermore, commercial interests are keen to cash in and maintain the dominance of alcohol in Irish society. This thesis concludes that this factor, in connection with the accelerated modernisation that Ireland has experienced since the mid-nineties, has malleable consequences for Irish society. As Keohane and Kuhling (2007) assert, post-modern consumption patterns of excess and ‘insatiability’ have been introduced into contemporary Irish drinking patterns and are affecting the nature of alcohol consumption in Ireland.This resource was contributed by The National Documentation Centre on Drug Use.

A Step in the Right Direction: An Evaluation of the Fáiltiú Information and Advise Service

The Fáiltiú service provides information and advice on rights, entitlements and options to homeless people, or those at risk of homelessness. The objectives of this evaluation were to assess the information needs of users of the service, how effectively they were being met, and how they could be improved. Two focus groups of staff members and service users gave their views on the design and implementation of the research at the outset of the project. A screening questionnaire identified 78 people who used the Fáiltiú service in a specified time period, of whom 40 participated in the evaluation by giving their views on the service. The study reviewed the literature on homelessness, attempted to define the term, and examined the characteristics of homeless people and relevant Irish social policy. The conclusions reached were: users of the Fáiltiú service are marginalized in a number of ways and share characteristics related to poverty and social exclusion, such as poor educational qualifications, high levels of unemployment and experience of prison; their needs are multi-dimensional and include accommodation, financial, social and medical support, and access to employment and training services: the service needs to respond to these needs in a holistic way.This resource was contributed by The National Documentation Centre on Drug Use.

A Study of a Staff Alcohol Policy in a Large Public Health Organisation, Looking at the Policy Content, the Policy Development and the Implementation Process, and the Policy Impact

There are different approaches to dealing with alcohol related problems in the workplace. A literature review indicates that two of the models that underpin programmes to deal with alcohol related problems in the workplace are the disease model and the health promotion model. The disease model considers alcoholism as an illness and uses curative techniques to restore the individual to sobriety. The health promotion model looks at the determinants of health and promotes changes in the environment and structures, which would support healthy behaviour in relation to alcohol. Employee Assistance Programmes (EAPs) may have elements of both theses models. Dealing with alcohol problems at work involves a captive audience and the workplace as a setting can be used to influence healthier lifestyles. A workplace alcohol policy is a mechanism through which alcohol related issues might be dealt with, and the necessary resources and commitment of managers and staff channelled to this end. The policy aims should be clear and unambiguous, and specific plans put in place for implementing all aspects of the policy. In the case of the alcohol policy in the organisation under study, the policy was underpinned by a health promotion ethos and the policy document reflects broad aims and objectives to support this. The steering group that oversaw the development of the policy had particular needs of their own which they brought to the development process. The common theme in their needs was how to identify and support employees with alcohol related problems within an equitable staff welfare system. The role of the supervisor was recognised as crucial and training was provided to introduce the skills needed for an early intervention and constructive confrontation with employees who had alcohol related problems. Opportunities provided by this policy initiative to deal with broader issues around alcohol and to consider the determinants of health in relation to alcohol were not fully utilised. The policy formalised the procedures for dealing with people who have alcohol related problems in an equitable and supportive manner. The wider aspect of the health promotion approach does not appear to have been a priority in the development and implementation of the policy.This resource was contributed by The National Documentation Centre on Drug Use.

A Study of Alcohol Problems and Marriage from a Treatment Perspective

This thesis is concerned with alcohol problems and marital relationships. It is particularly interested in these dynamics from a treatment perspective. The study addresses theory, research and clinical practice in the field of alcohol problems. It specifically considers these areas as they relate to enhancing understanding of the dynamics between alcohol problems and marriage. The study examines three theoretical paradigms, the disease concept of addiction, behavioural/cognitive behavioural and systems based approaches to understanding alcohol addiction. This provides a multiple theory base from which research in the field and the clinical data collected in the current research is analysed and interpreted. The study reviews research findings that have contributed to the recognition of marital treatment interventions as significant in the alcohol field. It highlights the discrepancies between such research findings and developments in actual clinical practice. In doing so, the study illustrates the gap between theory, research and clinical practice. The need for a more effective framework of information exchange across these areas of activity is identified and a model for better exchange is presented and discussed. This model highlights the importance of including clients' experiences to influence policy, practice, theory and research. In the research, specific attention is focused on the experiences of couples in alcohol treatment. Clinical data is collected from a series of alcohol treatment couples group therapy sessions. The research analysis of the clinical data identifies and extracts concerns as expressed by couples in treatment. Interpretation of these identified concerns or themes is conducted by employing the theoretical constructs of the three selected theoretical paradigms in conjunction with group work theory. On the basis of the findings in this thesis a model for a maritally sensitive assessment framework is developed. The model identifies a number of factors that should be considered in order to enhance appreciation of the interaction between alcohol problems and marital dynamics. This has particular significance for treatment interventions.This resource was contributed by The National Documentation Centre on Drug Use.

A Study of Sexual Health Issues, Attitudes and Behaviours: The Views of Early School Leavers

This research aimed to explore the sexual attitudes, beliefs and behaviours of early school leavers and how a group of young people, without the advantage of completing post-primary education, deal with the complicated issues of constructing, defining and experiencing sexual practice.This resource was contributed by The National Documentation Centre on Drug Use.

A Study of the Number, Profile and Progression Routes of Homeless Persons before the Court and in Custody

This study aimed to obtain information on homeless people appearing before the courts and in custody in the Dublin Metropolitan area and to track and to determine how homeless persons progress through the court and prison systems. The overall objective was to provide information the Probation and Welfare Service's processes of policy formation, service development and planning. Findings on the number of homeless offenders, their profile, their progression routes into the criminal justice system and prisoner reintegration are presented. Recommendations are made regarding sentencing policy, agency responsibility for ex-prisoners and appropriate issues for discussion by the Cross Departmental Committee on Homelessness. It is also recommended that drug free units be available across all closed regime prison establishments.This resource was contributed by The National Documentation Centre on Drug Use.