Highlighting lethal links between drink and drugs

Alcohol and drug abuse and the links between them are the major
medicosocial problem in Ireland today, according to Dr Michael
ffrenchO'Carroll. Elizabeth Doyle talks to him about his new book

Dr Michael ffrenchO'Carroll's experience of the Irish social and medical
scene stretches back to the 195Os when he worked with Noel Browne fighting
the great scourge of that time TB. To him a link between those days and
today's running battle against what he sees as Ireland's contemporary
epidemic drug abuse is as plain as night and day.

"Remember that once in this country we had a huge problem with TB and I
remember exactly the same stigma. In fact, the situation was so serious
that a TB allowance was actually paid to persuade people to come in for
treatment."

Dr ffrenchO'Carroll, who now works as an addiction consultant to the Cuan
Mhuire Centres run by Sister Consilio Fitzgerald, is the author of The
Irish Drugs Epidemic, published this month, in which he articulates his
belief that, taken together, alcohol and drug abuse is the major
medicosocial problem in this country today. And the link to alcohol is
crucial to his philosophy. To him drink and drugs are far from being two
separate problems, though some may not initially see the connection.

Some 75 per cent of 12 to 18yearolds are using alcohol, and among
teenagers alcohol and drug abuse are interlinked the former often acting
as the gateway to the latter. "What's happening with teenagers is that the
quantities of alcohol they're taking are enormous. We're dealing with
teenagers consuming alcohol in quantities which would be abusive even for
adults."

Dr ffrenchO'Carroll was appointed Director of Community Care and Medical
Officer of Health with the Southern Health Board in 1976. In the early
198Os, he established a treatment centre, Arbour House, a separate unit for
alcoholics in St Finbarr's Hospital, Cork. He also gave seminars in Cork
schools about alcohol and drug abuse, but was disappointed with the
response from parents. only about 2O per cent turned up to evening seminars.

Dr ffrenchO'Carroll has studied in the University of Michigan Medical
Centre and has worked in the United States on a number of occasions. Young
people there have to be 21 to buy alcohol, and bar staff, he says, are
careful to check identity cards because bars can lose their licences for
selling to minors. In Ireland the Intoxicating Liquor Act 1988 empowers the
Minister for Justice to make regulations providing for a national voluntary
agecard scheme to help to curb the supply of alcohol to persons under 18.
But according to Dr ffrenchO'Carroll, identity cards have not come into
practice because parents never demanded it.

"The situation in licensed premises generally is much too lax where the
verification of the legal age is concerned. The licensed trade should have
much more accountability. If a licensed premises serves alcohol to someone
under age, they should be warned on the first occasion, on the second there
should be some period of suspension, and where there is a third and fourth
violation the licence should be withdrawn."

Dr ffrenchO'Carroll has an MD in Community Health from Trinity College. He
has a particular interest in Epidemiology, the pattern of diseases in a
community. The approach he adopted in his Arbour House project in Cork was
based on methods used at the Hazelden Foundation Treatment Centre in
Minnesota.

Those taking part in the programme were assessed and treated at four
levels, physically, psychologically, emotionally and socially. Before young
people were accepted for treatment they had to stop taking alcohol and
drugs. But they also had to break away from peers and places which
encouraged abuse.

The typical teenager treated at Arbour House was someone who had passed
their Junior Certificate exams. But because of abuse, mainly of cannabis,
they would start to miss school, performance would decline and they would
either fail their Leaving Cert or drop out before that.

While the young people in Cork came from all areas, from the richest
suburbs to the deprived housing estates, Dr ffrenchO'Carroll says:
"Addiction is predominantly a problem of poverty. The young people I am
talking about who are abusing alcohol and cannabis in areas which are
socially deprived find themselves, when they drop out of school at 15 or
16, in an absolutely hopeless position.

"They're not capable educationally of further training and rehabilitation.
They're going to need active treatment. Unless we're able to respond to the
needs of these young people after they have been treated successfully,
you're going to have a huge increase in young people who are illiterate and
not only unemployed but unemployable."

He believes addicts in the middle and upperincome groups have more
resources for dealing with the problem. They don't have to resort to crime
in the same way because of their financial position and can get private
treatment and rehabilitation.

Parents usually find out about a teenager's addiction when a garda calls to
the door. That may be three years down the road. Teenagers are much more
knowledgeable about the effects of alcohol and drugs than parents, who
don't have the information or the skills to penetrate this underworld. In
his book, Dr ffrenchO'Carroll tells the story of how one family found out
about their son's addiction.

"John (18) borrowed the car one night on the pretext of taking the dog for
a walk on the beach. Instead, he drove there with three friends. They spent
about two hours smoking cannabis with the windows closed up in order to get
a better buzz. The dog was locked in the boot. "When he got home, his
father, worried about the dog, discovered him still in the boot. He wasn't
able to walk so they took him to the vet and found that he was intoxicated
on cannabis fumes and had traces of it in his bloodstream.

"It may sound bizarre, but at least one family were thus alerted to a
problem in its ranks that previously the parents had no suspicion of
whatsoever."

Often, however, the situation is exacerbated by the fact that parents may
have problems of their own, including marriage difficulties, as a result of
their own alcohol abuse. They may need help as much as their children.

There has, he believes, to be accountability on the part of parents. "if
they're going to be involved in alcohol and drug abuse themselves, they
can't expect their children to do otherwise.

Now based at the Cuan Mhuire branch in Athy, Co Kildare, he has been
studying the drug problem in Dublin where methadone which, he believes,
should be a last resort is used in response to heroin addiction. He
believes drugfree treatment should be the first option and cites US
studies which show that an addict had to be receiving methadone daily for
fourandahalf years in order to break a drug habit. Findings also showed
that during the methadone treatment programme a high proportion of addicts
continued to use alcohol and cannabis.

Methadone has now become a street drug so that like tranquilisers some
years ago we have methadone coming from legal and illegal sources. It's a
very serious situation, that parents, because they can't get to
professionally operated detoxification facilities, are going out and buying
methadone themselves in an effort to detoxify their own sons and daughters.

Dr ffrenchO'Carroll believes the Government should respond by providing a
comprehensive programme for the whole country which would involve
prevention programmes in primary and secondary schools and in the workplace
and early intervention in communities where prevention has failed.
Prevention and intervention need to be backed up by outpatient treatment
facilities and rehabilitation in all communities throughout the country.

"It's going to cost money, but the money involved in the provision of these
services is very small compared to the cost of the social implications of
untreated addiction for the whole nation."

Because of the role alcohol plays in Irish society and culture and the
spread of drugs, Dr ffrenchO'Carroll believes that it's a medicosocial
problem which demands a parallel response involving the Garda and the
courts along with the medical and social services.

"The Irish Drugs Epidemic" by Michael ffrenchO'Carroll is published by The
Collins Press, Cork, at £6.99.