TREATMENT IS ABOUT KEEPING THE DOOR OPEN

John Crimmins's close family experience of drug abuse moved him to a
career in the treatment of drug abuse. For seven years he was manager
of the residential drug treatment facility in the Merchants Quay
Project, and has since moved on to explore other avenues of addiction
and treatment. He trained in psychotherapy in Trinity College and has
set up in private practice.

``I was on the coalface for seven years dealing with poly drug-users,
but heroin addicts in particular. What I do now is generic
psychotherapy, but I specialise in drug treatment.

``We have also set up a home studies course which is designed to
impart knowledge to people living with addiction themselves or who
have been affected by it in some way.''

The course is designed for any and all addictions gambling, alcohol,
drugs because ``everybody in Ireland is touched in some way by addiction.

``There is a huge need there because there is very little knowledge
about addiction and our counselling courses are booked out.''

The home study course runs over six months, a module a month and,
amongst other things, deals with the different types of addiction, the
methods of treatment and the pharmacological aspects.

``The response from all over the country has been enormous, with a lot
of interest from nurses, social workers, the clergy.

``One prisoner in Mountjoy wants to do the home study course, which is
very exciting. We would love to offer it to the Department of Justice
as a pilot scheme.''

The most prevalent current thinking in addiction treatment is the
abstinence model, where addicts must be substance-free before they can
receive treatment; often people must wait up to six months for places.
The Merchants Quay project treats those still addicted but has only 12
beds.

``Outpatient methadone treatment is very common but treatment has to
have a three-pronged approach: the medical support, ie the methadone,
psychological support and the social aspects.

``The chances of success where a recovering addict is back in the
environment in which they became addicted are virtually zilch.

``Drug addiction is a multi-dimensional problem. Addicts need to be
linked into services and there are many different issues to address.

``Something like 80 per cent of addicts have Hepatitis C, so many of
them think they might as well go back using. Many are in denial about
their addiction, many have ingrained behaviour patterns.''

Crimmins describes ``Why do people become addicts?'' as the $64m
question. There are different theories. Some believe it is a
medical/psychological problem where a person becomes addicted to
something as a means of escape or because of a problem.

``The biological model treats addiction as a disease, like the
alcoholic, but does a smoker have a disease?

``Questioning this can cause problems for people who can accept their
addiction as a disease but not as a different sort of problem.

``Addiction can also be caused by environmental factors such as
deprivation, boredom and sheer substance prevalence.''

John feels that needle-exchange programmes are a good first step in
helping heroin addicts, they are a way for a centre to build up a
relationship with addicts so that when they come to a point where they
want to change, they know where to turn when the mood takes them.

``Drugs are pleasurable, so if you're a counsellor or therapist you're
the enemy because you're taking that pleasure away.

``It is important to be viewed as the person who will work with them
to gain a better standard of life.''

John Crimmins does not want to belittle existing methods of addiction
therapy, but he believes it is important to treat people whenever they
seek help. At the Addiction Training Institute they work with
individuals and groups and the important difference is that they will
work with addicts at any stage of their addiction.

``The 12-step abstinence model is not suitable for everyone, whereas
the Wheel of Change model gives a lot of hope.

There are four phases: Pre-Contemplation, where a person is using but
not aware they have problem.

``Then there is Contemplation, when they realise there is a problem.
Action is when they decide to do something about it, and the fourth
stage is Maintenance, once the person is clean.

``It is a cycle and hopefully the person will come off the wheel, but
relapse is part of the process of recovery.

``Amongst heroin addicts there is a 20 per cent recovery rate and many
of them can have up to five relapses. Because it is a cycle every now
and again windows of opportunity for treatment come around, where a
person is motivated to change treatment can be effective.''

The system is based on the theory of harm reduction. Indeed,
abstinence itself can become an addiction.

``Not everybody is ready for abstinence, and they may never be. If you
can improve their quality of life while still addicted, down the road,
who knows, they might choose abstinence. It's about keeping the door
open,'' Crimmins explains