Dr. Des Crowley:

Initially, obviously, patients present. First, we need to have a safe space where patients would be willing to reveal information about something that is criminal. Creating such a space is the first step. Second, we must be non-judgmental with patients so they will reveal their level of use. Third, we must determine the diagnosis. We must be careful in this regard. There is drug use, drug misuse and drug dependence, and the people we want in treatment are those who are dependent. Those are the diagnostic criteria we use. Once we have a diagnosis, we look at evidence-based treatment to match the diagnosis of dependence. There is a selection of evidence-based treatments for each of the different addictions.

What happens in reality, however, is that is time-consuming and we do not have the time we would need to do a comprehensive assessment. Additionally, treatment is often not available locally. We would like to think that in each region we would have a treatment service for cocaine and a treatment service for benzodiazepines. That should have an element of specialism. Where people are high complexity, they would go into specialist services. There should also be a very good primary care-based service where less complex patients could be managed. We do not have that and need to expand on it. The recovery aspect is very piecemeal as well. We have many good, well-funded organisations that are funded through the HSE, but the issue here is again about co-ordination. Some treatment services are replicated in some areas, while some regions have no treatment services at all.