Your Local Health Office of the Health Services Executive (HSE) provides a comprehensive alcohol addiction service, funded through the Department of Health. There are also a number of private programmes, which offer help to those trying to combat the effects of alcohol addiction.
Alcohol abuse is a problem that can affect people of any age and background when they intentionally overuse alcohol. It is a serious medical and social problem but is not the same as alcoholism.
Alcoholism is a medical disease and people with this disease need treatment, counselling, or medical attention to learn how to stop drinking and to live a healthier life.
This document provides an overview of the various types of alcohol addiction treatment services available and the support structures in place to help families and friends of those affected by alcohol dependency.
Each HSE Area is required by the Government to provide mental health services for the community. These services are centred in the community care programme and are supported by family doctors (GPs). Addiction counsellors work within the mental health team, which usually consists of a consultant psychiatrist, a social worker, a community psychiatric nurse and administrative staff. The HSE also runs a number of residential programmes for those with alcohol problems.
The family doctor (GP) plays an increasingly important role in supporting patients with alcohol problems and most referrals to addiction treatment services in Ireland come from GPs. The Health Promotion Unit of the Department of Health is involved in providing support to GPs with patients seeking help for alcohol abuse. The Unit runs seminars and lectures and through the Alcohol Aware Practice programme, has provided specialised training for GPs to help them deal with patients with alcohol-related problems.
There are a number of private treatment services for alcohol addiction in Ireland. The services they provide are very similar to those provided by the Health Service Executive (HSE). You will have a choice of residential treatment or treatment as an out-patient. Individual and group therapy will be used to help you understand and control your drinking and programmes will usually include help for families and those affected by someone's drinking problem. Private treatment programmes are not free of charge and prices will vary depending on the programme. However, easi-pay plans are available from a number of private centres and costs can be negotiated on a case-by-case basis. These costs may be covered by social insurance or private health insurance.
Alcohol addiction can be treated on both an in-patient and out-patient basis. This will depend on the patient's circumstances and their own personal preferences. Most people are treated within the community as out-patients and they can receive treatment and counselling in out-patient clinics and day hospitals. If the alcohol dependency problems are combined with other psychiatric or health issues, the patient may get home visits from health care professionals like a district nurse or a psychiatric nurse. A psychiatric social worker will be working in the mental health team alongside the addiction counsellor and may be asked to act as a liaison between the various people working on a particular case, such as the courts and probation services or social welfare services. Depending on a person's treatment needs, he or she may be referred back to his or her GP for continuous care.
If a GP has recommended treatment for alcohol abuse, an out-patient clinic will probably be a person's first contact with the Local Health Office's addiction treatment services. An out-patient clinic is a clinic in the community where people attend, usually by appointment, for either an assessment, follow-up or continuing management of their addiction. These clinics are often based in HSE health centres. Addiction counsellors also work out of day hospitals. As well as addiction counselling, community care services may run other alcohol-related courses. Family therapy, couples therapy, and groups for concerned persons will address the issues that problem drinking can bring up in these particular relationships. Courses for problem drinking and controlled drinking aim to help people manage their drinking. Information programmes are often run for professionals (e.g., health care, social services, courts and probation services) and people interested in understanding the causes and effects of problem drinking. For more details of the services available in your areas, you should contact your Local Health Office.
If alcohol abuse is a factor in someone's history and you opt for addiction counselling, you begin by having an initial assessment with an addiction counsellor before being referred on for further treatment. This assessment is a frank discussion between you, the counsellor, and, perhaps, family members or concerned individuals who have been affected by your alcohol abuse. The addiction counsellor will discuss treatment options with you, then you will be sent for a medical assessment. When all the information is to hand, you can make a decision about treatment options, based on the advice you have received. During counselling, people are encouraged to cut out alcohol completely. However, it is also recognised that abstinence may not be possible to achieve in the short term. Your addiction counsellor will advise you on how to deal with your drinking. Generally, the addiction counsellor will judge every case individually and there is no absolute rule about abstinence. Most addiction counsellors belong to the Irish Association of Alcohol and Addiction Counsellors, the accrediting body for addiction counsellors in Ireland.
If someone's drinking has resulted in hospitalisation, a consultant psychiatrist will assess him or her to determine if their condition and state of mind require in-patient care. If the patient has adequate family support, he or she may be referred to an addiction counsellor to deal with their drinking problem and sent home to be treated on an out-patient basis. If there is no outside support network, a person may be admitted to hospital until his or her condition is stabilised and then referred on to addiction counselling. Detoxification can sometimes be carried out in a public hospital if someone's medical condition makes full-time supervision necessary.
If someone is suffering from psychiatric problems like depression or psychosis and these problems are accompanied by a drink problem, he or she may be given a bed in an acute ward of a psychiatric unit. However, alcohol addiction is not seen as a psychiatric illness or addiction alone. If it is not accompanied by mental illness then it will not be treated in a psychiatric unit.
Before undergoing some counselling programmes (particularly residential programmes), clients must have gone through a detoxification programme. Detoxification will remove the physical craving for alcohol that is a symptom of alcohol addiction. In most cases, detoxification will take place on an out-patient basis under the supervision of a GP. A reducing dose of a strong anti-anxiety drug, such as Librium, will be prescribed and administered for a period of about five to ten days to ease the effects of alcohol withdrawal. Detoxification does not deal with the psychological issues that cause a person to abuse alcohol. For a successful outcome, people usually have to go through counselling to understand their addiction and change their behaviour patterns. For more information, you should talk to your GP who can talk to you about a suitable detoxification programme.
In some cases, an alcoholic will require medically prescribed drugs to help them in the initial stages of treatment. The use of drugs to treat addiction is called "pharmocotherapy" and most of the commonly used drugs will be covered by the Drugs Payment Scheme. The main types of drug used in the treatment of alcohol addiction are:
In-patient treatment takes the client away from their usual environment and all sources of alcohol. Patients are weaned off their dependence on alcohol and begin a therapy programme, including group and individual therapy sessions and family interventions. Aftercare is an important part of all programmes. Most residential programmes last for 30 to 42 days. Age limits can vary depending on the programme. Some programmes are designed to deal with people as young as 15, while others may only accept over 18s. Programmes will generally have a small number of both male and female clients, (up to 10) who are housed in a HSE-owned house for the duration of the programme.Clients must be alcohol-free for one week before most programmes start and they may be referred back to their GP for detoxification if necessary. Referrals to most residential programmes can come from a doctor, social worker, the courts and probation services, community nurses and workplaces. You can also contact these programmes yourself and be assessed by staff. The cost of residential programmes varies, but it will generally be a small sum that will cover food, etc., for the duration of the client's stay. Depending on the programmes, the costs may be covered by a medical card or social welfare payments, e.g., disability benefits. For more details on payment methods, you should contact the treatment centre directly.
Group therapy for alcohol addiction allows addicts to help themselves and gain support from the other group members who are facing or who have overcome similar problems to their own. Groups will generally be run by a trained facilitator and will also deal with areas such as improving people's social skills and teaching them how to cope with their problems instead of turning to alcohol. They can give advice about living without alcohol and also provide education about the dangers of alcohol addiction. Family interventions, lectures and film and video presentations will generally be part of any group therapy programme.
Those with alcohol abuse problems can choose to undergo counselling on their own. This means that a therapy programme will be designed for specific person. During counselling, a person will be asked to examine the effect his or her drinking has had on himself or herself and those around him or her. The person will also be encouraged to look at the development of his or her addiction in an attempt to discover why he or she abuses alcohol. Target goals are set to try and establish new patterns of healthy behaviour. Different counsellors will use different methods, for example, a behavioural psychotherapy approach where behavioural self-control techniques are taught. An individual alcohol addiction programme will last for an average of six to eight weeks and is followed by an after care service.
Aftercare services are available to those who need them, however, you should be aware that your local health board may not always provide these services directly. If services are not provided in your area, your addiction counsellor can refer you on to a private treatment centre that runs weekly programmes for recovering alcoholics. These programmes give people an opportunity to talk about issues that may be troubling them and they also reinforce the counselling that they have received.
Alcohol addiction services that are run by your Local Health Office of the HSE are public services and all out-patient services are free of charge. There may be a charge for HSE operated residential programmes (this is usually in the region of 65 euro a week to cover food costs).
Many private residential programmes will operate easi-pay plans for clients that need the service and costs can be covered by social insurance. Private health insurance will cover stays in selected drug treatment centres. For more details about the programmes covered, you should contact you own health insurer.The costs of Campral and Rev'Ia, which are used to treat symptoms of alcohol addiction, can be reclaimed under the Drugs Payment Scheme.
Generally, you will access the alcohol addiction treatment services offered by your Local Health Office by talking to your GP and being referred to your local out-patients clinic. There you will be assessed and your treatment options will be explained to you.
Private treatment programmes vary in their admission requirements, so you may need to contact them directly to find out what you need to do. A staff assessment may be enough or you may need a referral from a doctor. If you need advice, your GP should also be able to help you. You can also contact professional bodies to find out more information about addiction counsellors in your area.
You can find alcohol treatment services in your area by using the Alcohol Action Ireland's on-line guide to alcohol services around the country.
Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.
Al-Anon and Al-Teen is a support group for relatives and friends of problem
drinkers/children of problem drinkers.
If you have a question relating to this topic you can contact the Citizens Information Phone Service on 0761 07 4000 (Monday to Friday, 9am to 8pm) or you can visit your local Citizens Information Centre.