Wasted
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BO’C:
The graphs indicate that the issue of alcohol abuse in Ireland has been steadily rising over the last two decades. Does the government acknowledge that? And what is the government’s approach to tackling this area?
Minister Wallace:
From our point of view in the Health Promotion Unit we’d be very concerned about the situation and I suppose one of the big steps taken last year was the Intoxicating Liquor Act. We do feel that the whole availability of alcohol in areas such as off-licences and supermarkets is a problem. The whole increase in the number of off-licences in the country has had a huge impact. So a couple of things have happened. The fact that people can’t buy drink in these places now past ten p.m.—that has been useful. The price of getting a licence for an off-licence was one hundred euro, we increased this to three hundred euro, because, again, of this whole forecourt access to alcohol and the presence of alcohol. We’ve also had the separation of alcohol and food in supermarkets and the removal away from the front door. We see this as very important, because whether we’re talking about alcohol or indeed if you look across all the addictions, including obesity, the same principle applies. The principle is that the environment in which we all do our business needs to change.
BO’C:
Are the changing of licensing laws and the changing of alcohol placement in shops merely just tinkering around the edges of Ireland’s alcohol problem? For instance, what are the underlying issues in Ireland that make our society so prone to alcohol abuse, and is government doing anything to tackle those underlying issues?
Minister Wallace:
We would look at the whole issue of advertisement and sponsorship also. The government decided in April 2008 to set up groups to look at these issues. Now, again, when you go into looking at these issues, things may seem straightforward at the beginning but then you see all the complexities with it. But we would certainly be saying if you look at rugby and the Heineken Cup and if you look across all the different sports you discover there is alcohol involved in the sponsorship of sport. We would see that as being an issue that we will be having a good look at. We can talk about statistics all day but one of the big concerns we have is the increase in younger women involved in alcohol and we have a graph we can show you which is actually frightening. In terms of alcohol-related discharges from hospitals seventy-five per cent will be men, twenty-five per cent will be women. But when you look at the seventeen-year-olds you discover forty-seven per cent are women and fifty-three per cent young men. The younger women issue as, indeed, the teenagers and the whole youth aspect to alcohol, is becoming more and more of a concern to us.
BO’C:
Just on that, I was in the Aislinn Centre recently in Kilkenny. They tell me they have fourteen beds, and that, as far as they are aware, it is the only residential centre in Ireland where juveniles under the age of twenty-one can be treated for addiction. When you take out HSE-owned beds and probation beds, it leaves four to six beds for the treatment of children for the whole of Ireland. So, if the government acknowledges there is a rise in alcohol abuse in Ireland, particular[ly] amongst young people, how come there are only fourteen beds in the whole country to treat young addicts?
Minister Wallace:
Treatment is a big issue across all the sides of it. There is a lot of treatment in communities and I’d be aware of a lot of treatment issues. But the big problem first of all is the early age with which people are actually starting to drink. One of the most important messages is that I’m not quite sure that parents have embraced the seriousness of a fourteen- or fifteen-year-old drinking. If I were writing a chapter in any book I would write a chapter on the importance of delaying the first drink. If we could delay it from fourteen to over twenty it would make such a huge difference. There are people who say to me they can’t understand why their loving child in primary and post-primary school didn’t do as well in the Leaving Cert and then dropped out of college. They don’t seem to see the link between the impact of alcohol on the young brain. So if there were to be one strong message, I would say the whole importance of knowing where children are. So government can do X, Y and Z, but way back at the very beginning of it—if I was to say I have a priority as Minister on the alcohol side—that priority would be the younger teenagers and in relation to the whole delaying issue.
BO’C:
So how do you get that message to parents?
Minister Wallace:
Well, I suppose through publications like yours, through the media and whatever. There are some excellent books available through the HSE in relation to teenagers and alcohol and I would direct parents to the booklet on teenagers because again, where are teenagers getting alcohol? Frequently the first access to alcohol is actually in the home and it may be in the presence of parents. It may be a case of, ‘Well, I’d rather have my children having a glass with a meal on Christmas Day,’ or whatever. But in fact, that’s missing the point that the delay is so important for the child. For a number of reasons: for the child’s brain, for the education and for the fact that the younger people commence drinking alcohol the more likely they are to have problems later on.
BO’C:
Do we have any idea how much an untreated addict costs society? I know for example in Northern Ireland they have produced a figure of half a million pounds sterling.
Minister Wallace:
Not necessarily in terms of money costs but we do in terms of the impact on the whole of society. I can give you some quick figures if you want. So for example in hospital discharges, there was a ninety-two per cent increase between 1995 and 2004. So we looked through statistic[s] in that period. Also in relation to liver disease, an increase in the same period by one hundred and forty-seven per cent. In relation to deaths it increased from 3.8 to 7.1 and again this issue of it being a contributory factor in road fatalities. There was a very interesting piece of research done in the northeast. It looked at the issue of accidental suicide and injury and fifty-five per cent tested positive for blood alcohol. A closer look, we find that forty per cent of traffic fatalities, fifty-five per cent of suicide[s] and thirty per cent of drowning[s] were all alcohol-related. So what does that tell you? There’s a kind of carelessness creeps in. Suicide is such a tragedy for young people but maybe theirs is an element of hopelessness in relation to the link with alcohol that leads to these deaths. So again it comes back to the delay is hugely important.
BO’C:
The accusation that is often [levelled] is that the drinks group is such a strong lobby in Ireland, creating so much employment, that it is very difficult for government to form a policy that will impact on their business model. Would you agree with that?
Minister Wallace:
From our point of view on the health promotion side our biggest issue is individual responsibility. Again with all the figures we have concerns in relation to the units. This business of ‘Am I a binge-drinker or not?’. A lot of people don’t actually realise that they are binge-drinking. So the current recommendations are that women should have no more than fourteen units and men have twenty-one in terms of weekly consumption. To me that would appear to be high. There’s a report due out shortly where the HSE are talking about reducing that to eleven for women and seventeen for men. What’s a unit? Do people realise that a unit is not a pint? It’s a small glass of wine, a measure of spirits. The whole affluence society we have gone through, when you go back through the years in the 1970s and 1980s, a glass of wine was a small glass of wine. Now there are big glasses of wine. Even if you go into a restaurant and order a glass of wine, what’s the measurement of it? Order a bottle of wine and you know it’s one hundred and seventy-five millilitres, but you order a glass and it’s hard to know. We would have concerns. In relation to what we’re doing about it, we are looking at another piece of legislation, the Sale of Alcohol Bill, which we expect to hopefully publish before the summer (2009), but again it’s not on our side, it’s on the Department of Justice’s side.
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I personally think the Intoxicating Liquor Act was a great day in terms of the impact, because if I were to say to someone last May or June, what had the biggest impact, they all would have said the development of off-licences in every little village in Ireland. The whole culture of that. Once again we are talking about small steps making a difference. But the fact that in a village if they feel they have enough with one or two off-licences they can object to the District Court.
BO’C:
Is the point not this, though: that it’s still acceptable in Ireland for a father or mother to bring their son or daughter into a bar at fifteen or sixteen and buy them their first drink?
Minister Wallace:
Well, it isn’t acceptable and it shouldn’t be acceptable. It’s against the law. My understanding is if that was to be happening it is more likely to be at the kitchen table. Certainly the publican or barman should not serve alcohol even with the parent present.
BO’C:
Can we go back to the treatment side of things, given that we know the problems exist? It’s my understanding that someone cannot present to a psychiatrist and be admitted for alcohol-related problems unless there is a risk of suicide. All cases now have to be referred back through family doctors. So I’m wondering on the treatment side are there enough beds to treat adults and are you satisfied that if someone presents to their local GP or psychiatrist with a problem, are there proper processes in place to treat that person?
Minister Wallace:
I’m over twenty years in public life and would have dealt with a lot of people across the table that really wanted to do something about their difficulty and thankfully I have a met small percentage that have had success. Chiefly, my experience is that the individual themselves have to be committed. Without the commitment you can have two hundred family members that can afford the Rutland Centre or the best private care and nothing might change. It’s really about the culture of support around that individual, the messages we’re giving about the unacceptability of their behaviour. A family can be committed in the best of ways but if the individual isn’t committed then it just doesn’t succeed.
BO’C:
Specifically in relation to the Aislinn Centre in Kilkenny, they say [they] are strapped for cash and trying to get government recognition and support for their work. They have fourteen beds with over ninety persons on a waiting list late last year to try and get in and avail of their services. These are young kids who have taken that first step and admitted they have a problem and need help. So what does that say in terms of government’s acknowledgment of the problem of young drinkers when these kids cannot get treatment?
Minister Wallace:
I’m not familiar about what happens in Kilkenny; I can only talk about my own community. I know there is a one in three success rate for treatment programmes. I’m delighted for the one in three who makes it but what I’m actually more worried about is those who never got into the group of three. Those who never got beyond the step of going for treatment and it wasn’t for the lack of services. It was for the fact they changed their mind as an individual and they will be the people I would come across most in community settings. I’d have the family around them saying to me, we had everything set up, the appointment was made for next Thursday morning, say, we were all systems go, he or she has been off it for the last couple of weeks, and then Thursday morning comes and he or she wouldn’t get into the car. I think that’s the tragedy of the culture and so I think . . . you’re lucky to be the three that go across the threshold. From my point of view it is how do we get people into the situation of going for treatment? Some people can have alcohol in their lives, others can’t.
BO’C:
Would you be in favour of raising the legal age to twenty-one years?
Minister Wallace:
I would be in favour of it. What really saddens me was story I heard about a community where a twelve-year-old birthday party was held. One twelve-year-old was able to say to the other twelve-year-olds, ‘Listen, do you need any alcohol?’ That happened in a community in this city. I think really it’s the twelve to fourteen is such a fragile age group. Their parents have a duty to protect them.
——
I decided to meet with Dr Moosajee Bhamjee, a consultant psychiatrist, in his offices at Shannon Health Centre. Dr Bhamjee entered the national consciousness following his General Election win in 1992, when he took a surprise seat for the Labour Party in the Fianna Fáil stronghold of County Clare. He was the first Muslim td elected to Dáil Éireann (or, as many remarked at the time, the first Indian among the cowboys). When I bumped into him outside the West County Hotel, shortly after his election win, he himself summed up the electoral win with the memorable phrase ‘O’Connell, it is a black day for Fianna Fáil’. His day-to-day work is as a senior clinical psychiatrist, and over the last 20 or so years he has worked at the frontline of substance and alcohol abuse in the mid-west. He has experience, then, of working within both the health lobby and the political one and I was interested to hear from someone born outside Ireland, who perhaps could cast a more detached eye over our societal habits.
Having grown up in County Clare in the 1980s, I knew there was a huge stigma attached to seeking treatment for alcohol-related problems. Bushy Park was the nearest treatment centre and had the cultural associations of a place where you went at your lowest ebb. In-jokes between Ennis revellers had us all going to Bushy Park on many a shaky Monday morning following a heavy weekend session. ‘Jesus, I should be in Bushy Park,’ was the general gist. It was more or less held in the same light as Our Lady’s Psychiatric Hospital was a generation earlier—a place for the hopeless and those who were cast out by general society. Needless to say, words such as ‘rehabilitation’, ‘counselling’, ‘support groups’, ‘making amends’ and so on never got a look in. So, have times changed and is there an acceptance now among the wider community that alcohol abuse is an illness like any other?
‘I think people have come around to realise alcohol can be a problem and so it’s good to see all these new alcohol treatment centres for adults opening all throughout Ireland,’ says Dr Bhamjee. ‘But most of them are private, and a lot of people with medical cards don’t have access to the facilities. So the State has been negligent in a sense. The State has also been negligent in treating a person for alcohol withdrawals. It used to be done in psychiatric units before. The situation now is that the Inspector of Mental Hospitals and Mental Health Commission don’t want withdrawals in psychiatric units, so they asked us all to stop treating people for alcoholism and to refer them to the medical wards. It is now for medical people to treat people for withdrawals. But medical beds are in short supply, so people only stay one night or two nights and there is no proper detoxification process taking place. There is certainly nowhere to detox young people, unless they say they are suicidal; then they can go into [a] psychiatric unit for seven to ten days. The State is talking one thing and at the same time it is not providing the service for people, including drug addicts.’
Dr Bhamjee has seen Irish society change from a pub-orientated culture to one where drinking has become far more commonplace in the home.
‘The pub atmosphere has changed a lot since I came to Ireland. More shots are being drunk now towards evening time and because of things like the drink-driving people are now drinking at home, where they tend to drink more. Price has also become a factor—alcohol really is twice the price in a pub, so the off-licence trade has increased and increased. Being able to buy drink from a supermarket is also a huge cultural shift. I know that a lot of housewives with their daily shopping are now buying wine, and wine has now attracted massive sales. Some are drinking a bottle as part of their supper and feel quite normal.’
He agrees with Minister Wallace that alcohol abuse is a societal problem that requires a poly-pharmacy response. At the point when persons present for treatment, it is vital, he says, that they receive the proper supports.
‘Adults
need to take responsibility. We all of us have to share in this problem. We need to bring in a certain amount of control in drinking. There are people who know nothing else except the pub, so once they come off the alcohol they need a life change. That means getting a new social life, new friends, new hobbies and new interests. There has to be a whole mindset change. I think the amounts people are drinking are the same, but the style of drinking has changed. The problems with it are also starting much younger; we’re now seeing full-blown alcoholics at twenty-two or twenty-three.’
When I mentioned my visit to a local secondary school, where no major discussions around alcohol use were taking place, Dr Bhamjee became animated. ‘People always talk about issues to do with school—these issues are parental issues. They are not school issues. We see that more and more nowadays when any problem is being talked of as the responsibility for schools. It’s parents that are supposed to talk to children and train them. We need to encourage children to play games and look at leisure time so that it is productive, and they don’t say, “We are bored,” which is a major excuse that is used.’
Speaking of the positives in the past few years, Dr Bhamjee feels now, at least, there is a greater awareness in society that alcohol can be a problem and that treatment is available. He says more and more he comes across families encouraging one of their members to seek treatment, whereas in the past in Ireland the problem would have been kept within the home and hidden from view. Yet he, too, refers to the apparently haphazard way in which alcohol addiction is treated in Ireland at government level. ‘There is no proper planning in Ireland for treatment of alcohol and drugs. There is no system in place. If someone presents to me, then the process is that they have to be referred back to their GP, who might send him or her to a day hospital. They then try to treat the [person] as an outpatient and will refer them to an addiction centre. But between all the different strands, there is no networking and no cohesion.’