Alcohol – ‘No Ordinary Pick Me Up’

October 7, 2021 by Paddy Creedon in Mental Health

For World Mental Health Day 2021

As we head towards our Freedom Day with confidence that Covid-19 is behind us and economic normality is just around the corner heading into 2022, a report published last week by the Health Research Board came in well under the radar. But when we talk about alcohol use disorder or alcohol dependency across the island of Ireland all the health warnings on alcohol consumption very quickly go by the wayside.

Here are the key findings 

• Despite high rates of alcohol consumption and dependence, the rate of treatment entry nationally is sub-optimal, with wide geographic variations
  • There was a five-fold difference between the lowest and highest rates (119 cases per 100,000 in Meath versus 633 in Waterford).
• Drinking patterns indicate high levels of alcohol consumption and prolonged use prior to treatment. The use of other drugs alongside alcohol was common. Cannabis was the most commonly reported substance used alongside alcohol while cocaine was the second most commonly reported substance used along-side alcohol.
• National rates of treated 
  • Alcohol Use Disorder (AUD) were
    •  270 cases per 100,000 annually
  • Alcohol dependence
    • 165 cases per 100,000 annually. 

• These figures fall well short of the identified target of 690 treatment episodes for dependent drinkers per 100,000 adults per annum**. 
  • These findings suggest that only 2–3% of those with dependence are entering treatment each year.

• A key question that warrants further research is what is happening to the other 97%-98% that go untreated every year and how many new people join the great untreated every year? 

** Note: International evidence indicates that about 10% of people with alcohol dependence will seek and commence treatment each year. Based upon Irish estimates of prevalence of dependence, a target of 690.0 treated cases per 100,000 populations per annum is expected.

 Conclusions

1. The proportion of people with alcohol dependence who enter treatment of alcohol addiction each year is low by international standards.
2. There is wide and unexplained geographical variation in rates of treatment attendance. 
3. Strategies for early identification of AUD, such as the Making Every Contact Count initiative across all healthcare settings, may result in greater treatment seeking in the near future.
4. There appears to be a need to better plan the provision of addiction treatment services, so treatment is available where and when people seek it, with opportunities to learn from locations with higher rates of treatment entry. 

As someone in long-term recovery from chronic alcoholism (a diagnosis given to me by a Medical Consultant back in 1977) and who has worked in Healthcare almost all of my adult life (including as an interim Clinic Manager at Smarmore Castle Private Clinic during the pandemic), I would like to add some suggestions. How can we best address the provision of treatment services (issues raised in 4 above) and get the long overdue national debate underway led by a NPHET type body with no vested interests on such a body:

1. Provide free online confidential Alcohol Use Disorder and Alcohol Dependency Assessments to everybody over the age of 15 (similar to how Covid tests were organised) with self, family, medical, workplace, or court referrals becoming the norm with the consent of the person with the alcohol issue.
2. Provide follow up on site assessments, prevention and education modules (medical, behavioural and psychological) again free at the point of delivery for those identified as requiring such interventions from No 1 above.
3. Introduce Intensive Outpatient Programmes (IOP’s) in every county in Ireland, in conjunction with existing service providers (both residential and non-residential) – as a matter of urgency.
4. Do the necessary longitudinal and cost benefit studies whilst benchmarking against International best practice.
5. Bring trauma awareness, trauma informed protocols and trauma focused modalities, into all interventions and associated care plans.
6. Expedite the statutory registration of all addiction recovery professionals so that all frontline people must hold a relevant statutory licence.

I am not and never have been anti-drink. For the vast majority that can ‘take it and leave it’, enjoy your tipple whatever that may be whilst respecting those of us who have decided to go that road less travelled…in the Addiction Recovery route where we have put the drink down for the last time, one day at a time.

Time to accept into our culture that

“ALCOHOL IS NO ORDINARY PICK ME UP”

Paddy Creedon 

World Mental Health Day – Sunday 10th October 2021