1^st March 2005

Response by Irish College of Psychiatrists to Strategic Taskforce on Alcohol – Second Report.

• Lack of coherent policy on treatment of alcohol abuse and dependence…………
• Services for young people with addiction extremely limited………..

The Irish College of Psychiatrists today (1^st March) broadly welcomed the second Report on the Strategic Taskforce on Alcohol – but stressed that the area of specialist treatment needs to be developed further.

The Irish College response focuses on the lack of a coherent policy on alcohol abuse and dependence.  Dr Bobby Smyth of the Irish College of Psychiatrists said today, “Currently the 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 extensively in quality and quantity across the country.  It’s also very clear to us that services for young people with addiction problems are extremely limited.”

In its response to the second report of the Strategic Taskforce on Alcohol, The Irish College of Psychiatrists note twelve recommendations for the development of Specialist Treatment Services - as follows:

1. The recently established Advisory Group in Mental Health Policy has convened an expert subgroup on drug and alcohol treatment. In view of the enormous cost burden that alcohol abuse is placing on Irish society, and the evidence that treatment is cost effective, the recommendations of this subgroup should be implemented as a matter of urgency.

2. We propose that the 4-tiered model as outlined in this document be considered as a template for services nationally.

3. Nationally, there is a need to develop specialist multidisciplinary outpatient addiction team (i.e. Tier Three Services), which can deliver support and training to Services at Tiers One and Two and act as a filter to ensure effective and rational use of expensive Tier four services.

4. We recommend that the specialist multidisciplinary outpatient addiction team should encompass treatment of both alcohol and illicit drug use. The skills involved in treatment of both alcohol and drug abuse are essentially similar. Developing separate services would involve inefficient use of resources.

5. Consistent with international practice and the reality of widespread dual diagnosis, we believe that a consultant addiction psychiatrist should lead the specialist multidisciplinary outpatient addiction team.

6. We recommend provision of an adequate number of consultants in addiction psychiatry around the country. We agree with the provisions outlined in the Hanley Report, namely one consultant addiction psychiatrist per 119,000 of the population.

7. In view of the central role of psychiatry within addiction treatment, and the frequent occurrence of ‘dual diagnosis’, we recommend that addiction services remain under the umbrella of Mental Health Services.

8. There is a need for greater integration between General psychiatry and Addiction services in the management of dual diagnosed patients. There is a need for joint care planning in such cases.

9. There is a need for a wide range of disciplines within specialist multidisciplinary outpatient addiction teams, in addition to the addiction psychiatrist. These include mental health nurses, addiction counsellors, psychologists, social workers and family therapists.

10. There is a need for both financial and staff resources to support the development of specialist multidisciplinary outpatient addiction teams throughout the country.

11. Consistent with the recommendations in the STFA Report (R7.5), and a whole series of other Government policy documents, we agree that there is an urgent need to establish accessible addiction services for adolescents across Ireland. To this end, specialist outpatient multidisciplinary adolescent addiction teams should be established. The four-tiered model provides a template on which such a service could integrate effectively with existing services in the community (See appendix 2).

12. In view of the contribution which alcohol and drug abuse play in many criminal offences, we perceive a great need to develop a more comprehensive addiction treatment service within the prison and forensic setting.

A copy of the full response from the Irish College of Psychiatrists is available by clicking here

The report was written on behalf of the Irish College of Psychiatrists by the Faculty of Substance Misuse, which included the following:

Dr Eamon Keenan MRCPsych
Dr John O’Connor MRCPsych
Dr Siobhan Rooney MRCPsych
Dr Bobby Smyth MRCPsych, can be contacted on 086-3837414
Dr Conor Farren MRCPsych