Ms Anita Harris:

I thank the members for the opportunity to address them today. I am deputy head of services at Coolmine Therapeutic Community. I am joined by Suzanne Tackaberry, a parent and graduate of Coolmine and now a recovery intern, who is using her lived experience to provide peer support to others on their recovery journeys.

Founded in 1973 in response to Ireland's escalating drug crisis, Coolmine Therapeutic Community has grown from a grassroots voluntary organisation into a national leading provider of therapeutic community services. In the last 50 years, our organisation has transformed to meet evolving presenting needs but our vision has not. We believe everyone should have the opportunity to overcome addiction and lead a fulfilled and productive life. This vision includes families.

Addiction does not affect the individual alone. Its impact is deeply felt, uniquely and differently, by each family member, including parents, siblings, partners and extended family members. This includes children. What we know is that children at risk of compromised parental care due to problematic substance use need targeted family support. Without it, they remain hidden, unseen, and unprotected.

Let me refer to the scale of the issue. National figures show us that one in 11 children in Ireland is affected by parental alcohol use. This is from Hidden Harm, 2019. The figures also show that 2,221 drug treatment cases in 2024 were living with children under 18 and that more than half of alcohol treatment cases in 2024 involved parents, with 3,290 children under 17 directly affected. Coolmine's figures reflect this. A total of 2,659 men and women received treatment and recovery services in a Coolmine service in 2024. Together, they had 2,998 children under 17 between them. Thirty-eight percent of these children lived with the parent in treatment; 39% lived with the other parent; 14% were in the care of the State; and 7% lived with extended family, namely, grandparents. These figures reflect only those parents who have reached out for help and who have received treatment. Thousands more remain unseen. I am referring to children living in silence and uncertainty, underscoring the profound reality of what has come to be known as hidden harm.

The Hidden Harm project, a joint initiative between the HSE and Tusla, provided policymakers and front-line agencies with a vital practice guide focused primarily on safeguarding, protecting and supporting children affected by parental substance use.

We recommend that this project be expanded beyond risk identification to include the development of robust protocols and a shared case management framework. By adopting a whole-family approach, services can respond more effectively to the complex and interconnected needs of both the children and their parents, ensuring no child is left behind in the recovery process.

The current national drug strategy 2017–25 includes important actions aimed at building service capacity to recognise hidden harm and support families affected by substance use. However, these actions, again, remain largely focused on identifying risk but not much more. We urgently recommend that the next national drug strategy move beyond recognition and towards action by embedding a comprehensive, whole-of-family approach. This requires significant investment in community-based services to enable early intervention, sustained support and co-ordinated care responses that address the full spectrum of needs for both the child and the parent.

Despite progress, critical gaps remain in Ireland’s policy, strategy and practice when it comes to supporting families affected by addiction. These gaps represent real harm to real children. A parent’s ability to access quality, family-focused treatments and supports in their community is the most powerful form of harm reduction for their child. Yet, this support is far from guaranteed. Integrated care pathways cannot exist without services being in place. Currently, there is a glaring absence of family-based services that treat the adult while simultaneously supporting the child. Without clear protocols or a shared framework to guide this work, hidden harm will continue to grow unseen, unspoken and unaddressed.

Coolmine urgently calls for a national review across four key areas. In policy, most adults in addiction treatment are parents, as seen from the statistics I mentioned, yet their parental role and their children’s needs are routinely overlooked in national policy and service design. This silence must end.

In terms of practice, evidence-based parenting supports are not consistently embedded in addiction services. As a result, children’s emotional, development and safety needs are often left unmet.