Oireachtas Joint and Select Committees
Thursday, 25 September 2025
Committee on Drugs Use
Family Supports: Discussion
2:00 am
Gary Gannon (Dublin Central, Social Democrats)
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I am delighted to welcome everyone to the first public meeting of the Joint Committee on Drugs Use. The committee will have nine months to carry out its work and I look forward to engaging with a wide range of stakeholders and having insightful contributions on this most important topic.
I welcome our witnesses who will engage with us later in this meeting. You are all very welcome. For those watching in we have: Mr. Andy O'Hara, co-ordinator, and Ms Annmarie Dunphy, peer worker, from Uisce drug support; Senator Frances Black from the RISE Foundation; Ms Cindy Barry, family support worker and Ms Gwen McKenna, director and co-founder, from the Family Addiction Support Network; Ms Yvonne Lyones, participant and peer researcher and Mr. Joe Slattery, co-ordinator, from the Northstar Family Support Project; Ms Anita Harris, deputy head of services, and Ms Suzanne Tackaberry, recovery intern, from the Coolmine therapeutic community; and Ms Aileen Malone and Mr. Michel Mason from Family Addiction Recovery Ireland.
Our agenda items today were sent in advance. As this is our first public session and before we begin, I must make a Cathaoirleach's declaration. It is very exciting. I do solemnly declare that I will duly and faithfully, and to the best of my knowledge and ability, execute the office of Cathaoirleach of the Joint Committee on Drugs Use without fear or favour, apply the rules as laid down by the House in an impartial and fair manner, maintain order and uphold the rights and privileges of members in accordance with the Constitution and with Standing Orders.
I will now turn to privilege. All witnesses and members are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him or her identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in relation to the identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.
I remind members of the constitutional requirements that in order to participate in public meetings, members must be physically present within the confines of the Leinster House complex. Members of this committee attending remotely must do so from within the precincts of Leinster House. This is due to the constitutional requirement that in order to participate in public meetings members have to be physically present within the confines of the places where the Parliament has chosen to sit. In this regard I ask any member partaking via MS Teams that prior to making his or her contributions to the meeting he or she confirms that he or she is on the grounds of the Leinster House campus.
I will make some opening remarks as this is our first public session this afternoon. I am genuinely proud to take up the role as the Chair of this committee. My very first involvement in politics was very obviously not in Leinster House but was as a community representative on the local north east inner city drugs and alcohol task force. For me in many ways this does feel like coming full circle. The fight against the devastation caused by addiction has always been close to my heart. It is the work of communities that first inspired me to get involved in public life. The Citizens' Assembly on Drugs Use was one of the most significant and thorough examinations of our national drugs policy the State has ever undertaken. Hundreds of people gave their time, their expertise and, in many cases, their lived experience to ensure this country finally had an honest reckoning with the failures and the possibilities of our approach. I wish to place on record my gratitude to those assembly members, to the advocates, and to the families who contributed, and to the members of the previous Oireachtas committee who laid so much of the groundwork that we now see in front of us. Their work should not sit on the shelf. It should shape the future of how we respond - with compassion, evidence and courage - to the realities of drug use in Ireland today.
In the short time since the committee was established we have been extremely busy as a committee. Amongst our different engagements we have listened to families, to the service providers, and to the front-line workers. All of us on this committee have seen up close the scale of the challenge but also the extraordinary resilience and compassion in communities right across the country. That work is ongoing and it deserves the space to breathe. This is why I want to raise a concern at the outset. We are told that a new national drugs strategy is to be published in full before the end of this year, which will be months before this committee has even concluded its hearings and produced its recommendations. To me this simply does not make sense. It risks cutting across the voices of advocates, experts and community leaders who have been waiting for this opportunity to be heard. My hope and my appeal to the Department is that what is published this year can be treated as an interim framework while this committee is undergoing our work, and that it remains open to the findings and the recommendations that will be made from this committee. This is because for those processes to be real and inclusive, I believe that any substantive findings from this committee must be incorporated into the national drug strategy.
I again welcome our witnesses as we begin engagement on our first module and our first hearing in public session. All the opening statements have been circulated to members in advance and will be published on the Oireachtas website after this session. As agreed, we will limit each opening statement to three minutes. I hope this will allow all the witnesses to answer questions from members following that. Our first witness is Mr. O'Hara from Uisce.
Mr. Andy O'Hara:
Ireland is embracing a major shift towards a health-led, human rights-based approach to drug use, reflected in the national drugs strategy, the Citizens' Assembly on Drug Use and the Oireachtas joint committee. A core principle of this new consensus is that policies and services be co-designed with the people they serve, yet meaningful engagement is impossible without independent support. Research shows people who use drugs often hesitate to voice concerns due to power imbalances in treatment. The Health Research Board highlights that stigma and discrimination block access to essential services, leading to poorer health outcomes and deeper inequalities. Without advocacy, individuals are left to face systemic barriers alone.
Ireland already recognises the importance of advocacy in other areas. The Mental Health Commission, for example, ensures advocacy is structurally independent of treatment providers so individuals can challenge decisions without fear of repercussions. People who use drugs deserve the same protection. Our front-line advocacy consistently reveals discrimination against people who use drugs across multiple systems: healthcare - stigma and refusal of appropriate care; housing - unfair evictions and denying applications based only on drugs use; Tusla - parents deemed unfit without proportional assessment, leading to family separation. These practices worsen exclusion, reinforce cycles of substance use and undermine recovery. This will continue as long as we stigmatise, criminalise and deny people their human rights.
The contrast in Ireland's investment in advocacy is stark. EPIC supports fewer than 6,000 young people in care with a national network of advocates, research and systemic influence. In comparison, there are tens if not hundreds of thousands of people who are drug dependent, yet advocacy infrastructure for this group is virtually non-existent. Uisce is the only independent national advocacy service for people who use drugs. Despite minimal resources, it achieves outsized impacts: 4,000-plus peer-led engagements and 188 outreach sessions annually; direct advocacy in complex cases involving healthcare, housing and child protection; harm-reduction leadership including naloxone training for over 1,000 people; authoring material on how to reduce drug-related deaths; campaigns and events such as international overdose awareness day, the "Support. Don't Punish." campaign and the close the gap conference; as well as ground-breaking research including an IHREC-funded agency access and solutions report and digital anti-stigma studies.
Independent peer networks with a national framework are critical to the change we are all trying to create. The State cannot simply hand-pick the individuals with lived experience who it finds palatable. This can undermine the principles of representation and independence. We must be accountable to and provide protection to a broader community which may be reluctant to criticise the system for fear of losing a place at the table.
It is therefore deeply concerning that Uisce, the national organisation named in the current NDS, has been excluded from the committee to oversee the new national drugs strategy. A national independent organisation like Uisce must be protected, mandated and funded to do this work. We are not a threat; we are the essential partner you have committed to working with. Investing in independent advocacy is not a cost; it is the foundation upon which a truly health-led, rights-based approach is built. It is the most effective way to stop the deaths, end the discrimination and finally honour the commitments we all have to save lives and build stronger communities. I thank members.
Gary Gannon (Dublin Central, Social Democrats)
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Our next contributor is Senator Black. She is having issues dialling in remotely so we will move on to Ms Barry to give her opening statement.
Ms Cindy Barry:
I thank the Chairperson and Members of the Oireachtas. I represent the Family Addiction Support Network, FASN, which operates across Louth, Meath, Cavan and Monaghan. FASN supports families affected by a loved one’s substance use, gambling or related addiction. We are a peer-led, trauma-informed, community-based organisation working with the families who are too often invisible in policy and service design. Families are left to cope with emotional distress, trauma, financial pressure, domestic violence, child welfare concerns and burnout, yet less than 3% of national drug strategy funding goes to family support services. Many areas have none at all and those that do, like ours, are chronically underfunded.
FASN provides a 24-hour helpline; weekly peer-led support groups across the four counties; one-to-one support and crisis intervention; training and education in addiction, trauma, and coping strategies; advocacy with services, prisons, treatment providers and social services; and counselling for trauma and bereavement. Our work prevents and manages crises, reduces family breakdown, provides support and education and improves treatment outcomes at a fraction of the cost of hospital admissions, prison stays, or social service interventions, but we are at breaking point. Despite proven outcomes, FASN continues to operate on short-term, piecemeal funding. Staff carry unsustainable caseloads. Volunteers face burnout and demand is increasing, due to increased cocaine and polydrug use, drug debt intimidation, substance and gambling-related harm, and intergenerational trauma. Without sustained investment, organisations like ours will be forced to reduce services at the very time families need us most.
Our call today is for dedicated, ring-fenced funding for family addiction support under the national drugs strategy; full integration of family support across the addiction treatment pathway; a trauma-informed, whole-family model adopted nationally and aligned with Sláintecare and Healthy Ireland; recognition of family members as key stakeholders; and improved NDTRS data collection specifically for concerned family members.
Addiction may start with one person but its impact ripples across entire families. At FASN we see how support can transform lives. We call for addiction family support services to be delivered nationally, adequately funded and recognised as a vital part of addiction recovery. With the right structures, funding and recognition, families can move from chaos to coping, despair to hope and silence to advocacy. They can reclaim their lives, support their loved ones towards recovery and become powerful voices for change. When families are supported, communities are stronger and recovery becomes possible for everybody. We urge the committee to ensure families are no longer the forgotten stakeholders in addiction policy. I thank the committee.
Gary Gannon (Dublin Central, Social Democrats)
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Many thanks. Our next speaker is Mr. Slattery from the Northstar Family Support Project.
Mr. Joe Slattery:
I thank the committee for inviting my colleague and me to share our experience of working alongside families impacted by a loved one's drug or alcohol misuse. The Northstar Family Support Project is a long-established and well-trusted community-based service working with individuals and families in the Limerick region impacted by a loved one’s drug or alcohol use.
Due to the stigma, shame and emotional distress associated with drug use, especially for parents with adult children in addiction, people can go years before reaching out for support. During this time, they frequently withdrawn from many regular activities involving extended family, friends, social activities and employment. They are so focused on trying to help the person in addiction and protect the rest of the family from the impact of it that they are totally unaware of how much they have been impacted themselves, emotionally, physically and psychologically.
In many cases, family members are fearful of violence in the home or threats from drug dealers. There are also participants who fear that social services may get involved with their families, delaying their motivation to seek support. Addiction does not discriminate and impacts families from all walks of life and social standing. Regardless of where you live or how much money you have, the emotional distress and shame are the same. No one looks at their newborn child and thinks "Someday you're going to destroy your life and our lives because of addiction." Their hopes and dreams of how life will be for their child are gone and all they can do is grieve for what could have been, as opposed to what is.
There are several services providing supports for those misusing alcohol and drugs, but supports for families are extremely thin on the ground and, in most cases, poorly funded or provided as a secondary support. The impact of addiction on families is felt 24-7. There is no break. Christmas, holidays, family events like weddings, communions, funerals - the constant worry is always there.
Partners, especially those who are parents, are stuck in constant emotional turmoil regarding how best to respond to their loved ones. Addiction in the home tears families apart. Due to the severe lack of supports for people in active addiction who are not ready to change their drug-using behaviours, the only option parents have is to make them homeless or continue to live in despair. This is every parent's worst nightmare and something that is not done lightly. It usually happens only after many years of trying to fix a loved one's addiction issues. Try to imagine the level of despair it must take for a parent to say, "I wish they would just die so this pain would end", "Grieving them would be less painful than living like this", "I hope the judge locks them up so I can sleep at night knowing where they are" or "I would rather be dead than have to continue to live like this." Statements like these are voiced far too often and what motivates them needs to be addressed.
On the other side, many partners, predominantly mothers with children who are stuck in loveless, abusive relationships due to a lack of housing, have no choice but to live in the same home as the person in addiction. Such people live in fear and constant worry regarding how the environment will damage their children and what version of their partners will show up at the door.
Here are some direct quotes from the participants who attended Northstar:
Depression. Just didn't have the will to live because of despair of hopelessness.
My symptoms changed daily. I never know from one day to the next what's going to happen and how I'll feel.
I was in despair and crisis. Helpless and powerless, anxious, spaced out and confused. In depression.
The activities of Northstar, coupled with the trauma-informed ethos of the organisation, develop participants' self-esteem and confidence and support them in building a range of coping skills that enhance their day-to-day lives. Over time, this challenges participants to explore and address their life circumstances and personal traumas, fostering independence, particularly through one-to-one and peer support groups, access to counselling and a range of other personal development and social options.
Here are quotes from participants who attended the service:
Brought me face to face with my feelings. I had always run away from them before.
I am stronger now and can face things and stand up for myself, which I never could do.
Before I could never laugh at such things. Now I can. I can reflect on my life and laugh at what was at the time painful and terrifying. I am in a better place now. The past is over, and I can move forward.
Northstar Family Support Project is extremely lucky that it receives appropriate funding that allows it to provide a wraparound service to families impacted. However, we are fully aware that this is not just a Limerick city issue and that there are families throughout this country who are severely impacted by family members' addiction, death due to drug use, imprisonment due to drug use, homelessness, street begging, sex working, drug debt intimidation, and videos and pictures of loved ones showing up on social media who do not have a Northstar to turn to.
Family members are the collateral damage of addiction-----
Gary Gannon (Dublin Central, Social Democrats)
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We are over time. We can come back to Mr. Slattery during questions unless he wants to conclude quickly.
Mr. Joe Slattery:
Yes. The introduction stated five minutes. I did not realise I had three.
Family members are the collateral damage of addiction – the ones hurt the most, with relationships destroyed, bank accounts emptied and homes turned into war zones. They are left feeling bullied and intimidated and are made to feel they are at fault and to feel ostracised by their communities. They are heartbroken repeatedly by promises of change that never happens.
A supporting factor in people's recovery from addiction comprises the connections with and supports they have from others, including family. They are supported to work through their trauma and forgive their actions due to their addiction. What most people do not consider is that addiction is not a singular issue but a family issue impacting everyone. Everyone deserves the opportunity to recover and rebuild his or her life.
Gary Gannon (Dublin Central, Social Democrats)
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I thank Mr. Slattery. I invite Senator Black to speak on behalf of The RISE Foundation. She is very welcome.
Frances Black (Independent)
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I thank the Cathaoirleach for the invitation. It really is great to be here with guests from Northstar Family Support Project Limerick, the Family Addiction Support Network, Coolmine treatment centre, FARI and Uisce.
I will try not to talk for too long because I understand time is precious. I will just speak very briefly about what RISE does. The previous speaker has covered the exact impact on families and how devastating addiction is for them, so I will not go there. I will just say a little about what we do.
RISE is a primary care organisation that supports families in their own recovery, and in their resilience because the impact is so devastating. The aim of RISE is to help individuals manage the situation and empower families to rebuild relationships, develop healthy coping strategies and, to be honest, reclaim a little hope.
RISE has a five-fold approach. The first element is to support family members in their own recovery, because families need their own recovery process separate from that of the person who engages in problematic drug or alcohol use or gambling. Second, we try to educate families about the impact of addictive behaviour on them, not only on the addicted individual. Third, we try to break the cycle by encouraging self-care and boundary-setting. Fourth, we try to help families emerge from powerlessness with renewed strength and courage. Powerlessness can bring families into a devastating place, as the previous speaker said. Fifth, reflecting why we are here today, we try to raise public awareness about the ripple effect of addiction on families. Our core programmes are delivered by a team of eight experienced counsellors. We have an online family programme, which entails a weekly three-hour session. We offer one-to-one counselling and aftercare.
Today, I am not going to talk too much because I am conscious of time. However, it is important to ask the committee to recognise the importance of family support as part of a comprehensive public health approach in Ireland. It is vital. We need a national body like FARI, which is represented today and that represents the voice of families affected by problem substance misuse. We need investment to expand online capacity and train more staff in evidence-based family therapies. We need support for partnerships with treatment providers, primary care networks and community organisations to ensure seamless referrals and holistic care, which is vital. With appropriate funding and policy support, we can reach more families in need and reduce the long-term human and societal costs of addiction and strengthen the fabric of families across our communities.
The RISE Foundation offers a proven, compassionate and scalable model for supporting families affected by addiction, along with the work of the other wonderful organisations represented here today. I work very closely with Ms McKenna from the Family Addiction Support Network and I have been speaking to Ms Breda Fell from FARI, and I see the phenomenal work of all the other organisations in this area. I thank the members for their time and consideration and welcome any questions they have.
Gary Gannon (Dublin Central, Social Democrats)
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I thank Senator Black for her contribution. Our next contributor is Ms Anita Harris, who is to speak on behalf of Coolmine Therapeutic Community.
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.
Gary Gannon (Dublin Central, Social Democrats)
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Apologies, Ms Harris, we are a little over time and I want to leave time for questions. Is that okay?
Gary Gannon (Dublin Central, Social Democrats)
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I thank Ms Harris. I will give more time during the questions, I promise. I now invite Mr. Mason to give his opening statement on behalf of Family Addiction Recovery Ireland.
Mr. Michael Mason:
Family Addiction Recovery Ireland, FARI, is the new national organisation which supports anyone affected by someone else’s alcohol or drug use in Ireland, whether that person is still actively using substances, is in recovery or the concerned person is bereaved. We give information and support to family members and we link them to available family support services and, where available, local peer family support groups. We also help people recognise and understand the importance of looking after, and caring for, themselves.
As mentioned in the briefing document, we are a collective of service providers and voluntary individuals with vast experience of delivering evidence-based interventions to both individuals and groups, including peer family support over a number of years. We came together following the sudden demise of the previous national family support organisation, to ensure the continuance of a national voice supporting families.
When we say "family", we mean those who people see as their family. It could be their partner, parent, child or grandchild, sibling, friend, colleagues or neighbours, or anyone else we might have missed.
FARI’s work is underpinned by our five outcomes: that families are heard, supported, included, connected, and that families create change. Our vision is that families impacted by problem substance use are supported in a meaningful and effective way that enables whole family recovery. Families’ experience and knowledge is part of the recovery agenda and is integrated into the decision and policy making structures. FARI represents them in those structures as equal partners. FARI’s aim is to provide strategic and operational direction and leadership across all aspects of family support service work. For us as a new organisation, this involves ensuring effective governance, reporting and accountability, which is why we are at present in the process of establishing the organisation as a registered charity and a company limited by guarantee.
Since the closure of the National Family Support Network, we have endeavoured to be the voice of families in this critical period of Irish drug policy. In 2023, we were requested to represent families at the Citizens' Assembly on Drugs Use, where we effectively contributed to the discussions, as an organisation and individually, which we believe led to recommendations 14 and 22. FARI supports the full implementation of these two recommendations and all 36 recommendations of the citizens' assembly.
In 2024, FARI was part of the lived experience stakeholders for the evaluation of the national drug strategy, Reducing Harm, Supporting Recovery 2017-2025. Six recommendations around lived experience came from that evaluation and again, FARI believes we were part of that.
FARI organised an all-Ireland family support conference, Trauma in the Community, over two days in Dundalk in September 2024, in conjunction with FASN, with a small amount of funding granted to the Family Addiction Support Network from the Department of justice. Over 250 people attended, representing peer family support and service providers from all across the Thirty-two Counties of Ireland. A report of all the findings from the three world café round table discussions was collated following the conference. There were six recommendations from the participants at the conference: establish a national family support co-ordinating body, FARI; the expansion of trauma-informed care training for service providers and families; enhance availability and access to mental health services; support peer-led initiatives, diversion programmes for at risk young people and financial resources for respite and safe places for families under threat; target young people’s exploitation and grooming by drug gangs - it is a constant stressor for families, resulting in family breakdown; and an awareness campaign to reduce stigma and encourage those impacted by addiction to seek support, which is a significant factor for families accessing support.
Following the conference, FARI was launched as the new national body representing family support. Since then, FARI has printed full and executive summary reports of the conference and we can provide PDF copies to anyone who requests them. We are also, in conjunction with Citywide and Uisce, organising the first national service of commemoration and hope for bereaved families since before Covid in the Mansion House on 11 October.
We will have robust financial management and stewardship, maximising resources, including funder development and engagement. We will sustain and strengthen the range of services and programmes available to families such as the five-step method, CRAFT, bereavement support, and quality standards in facilitation of family support groups. We champion family rights and the role and contribution of families to services, campaigning for wider system and service changes and better outcomes for whole-family recovery through policy and practice.
We will oversee-----
Gary Gannon (Dublin Central, Social Democrats)
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I am sorry to interrupt. I promise that Mr. Mason will get time to make the rest of his points.
Gary Gannon (Dublin Central, Social Democrats)
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Mr. Mason did great. I will pass over to members. Each member will have five minutes. We are cutting everybody's time today. Members can ask a question of a specific organisation or speak more generally but I ask that they leave time at the end for contributors to answer the question within the allocated time slot. Senator Ryan will be first.
Nicole Ryan (Sinn Fein)
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No pressure. I thank the Cathaoirleach. My first question is for Coolmine. How do we balance the urgent need for specialised residential family units versus interventions in the community? How does Coolmine see that working?
Ms Anita Harris:
At the moment we have neither, so we have to meet both needs. Currently, there are only two mother and child residential centres in the whole country that provide treatments for mothers and children and Coolmine provides them. People would not have to come into Coolmine to take up a tier 4 residential bed if the supports were in the community. There is a handful of fantastic community organisations that support the needs of both parents and children but I could probably count them on two hands.
Nicole Ryan (Sinn Fein)
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I thank Ms Harris. My other question is for FARI. FARI's statement mentioned kinship carers needing to have the same rights as foster carers. Maybe Mr. Mason did not get to that part but I read the statement prior to the meeting. How widespread is the issue around kinship care versus foster care and how do we legislate for that?
Gary Gannon (Dublin Central, Social Democrats)
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Would Ms Malone turn to the mic?
Ms Aileen Malone:
It is difficult because I like to look at faces. Kinship care is often such an informal relationship and arrangement that it is difficult to actually quantify, so I will speak from my personal experience. My husband and I were kinship carers for our grandson and we looked after him for about 19 or 20 years. It was only in the last few years that it was officially recognised and that we actually got supports. Speaking from my experience of family support groups, I know quite a few kinship carers.
If I think of 30 people I have known, approximately five of those - one sixth of that group - were actively kinship caring. Usually, they are caring for grandchildren, but it can often be an aunt or an uncle caring for nieces or nephews as well. Does that answer the Senator’s question?
Nicole Ryan (Sinn Fein)
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It does. I thank Ms Malone. I really appreciate it. My other question is for Ms Barry. She mentioned that 3% of the drugs strategy’s funding goes to family supports. Does she have any insight into how that figure compares internationally?
Nicole Ryan (Sinn Fein)
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It is grand. Do not be sorry; it is a technical question. I might open that question to the floor. Are there other countries we could look to that support families a hell of a lot better than we do here in Ireland when it comes to addiction and family supports?
Mr. Joe Slattery:
The silence is an answer in itself. There are a lot of studies on how to approach people and adolescents in addiction. There are different models out there. No one has ever thought of the families, however. There is very little out there other than the research that we create ourselves by the people. For example, we get nice funding in Limerick. We can provide a vast amount of support to the people coming in. I tie in with other services like the family resource centre for the south east, but it has nothing. It comes to us asking how this is the case. I have a good relationship with the HSE. It is located down the road and it sees what we do. We give it strong evidence and the numbers prove it. Those HSE individuals in Limerick then back us up at the next level. Other services probably do not have the same relationship or that ability. It should not be that way.
Nicole Ryan (Sinn Fein)
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Is it that the HSE is not joined up in its thinking across regions or areas that groups must have a really good relationship with it? In Cork North-West, we do not have anything. We have to go to the city to get any type of addiction treatment for the person, never mind the families. The families are just forgotten about altogether. Is it that the HSE is siloed and does whatever it wants in different areas?
Ms Cindy Barry:
Our experience is similar to what Mr. Slattery said. Some other family support groups are well funded. For us in the north east, however, we are continuously meeting various Ministers and attending various meetings like this asking for the same type of funding. There does not seem to be a general approach to families. We do not have the same funding across the board. We spend a lot of our time trying to keep our heads above water, as well as manage the families’ needs. That is so difficult, especially with the rise of drug use and the crisis we are in at the minute.
Gary Gannon (Dublin Central, Social Democrats)
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We will move on to our next speaker, Deputy Marie Sherlock. She has five minutes. All members will get a second round of questions.
Marie Sherlock (Dublin Central, Labour)
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A huge thanks goes to the six organisations for being here today. I have three questions. I will put them out and then witnesses can decide how to respond. With regard to family supports, it is about the network services that are there. Obviously, it is hugely important that funding and recognition of the work the witnesses should increase. I am interested to hear the witnesses’ perspective as to how family support services should develop into the future and the extent to which they should be a stand-alone service or whether they should be integrated into harm reduction services or the family resource centres. I do not have a view in that regard but my concern is that someone somewhere will make a decision, someone in the Department of Health, for example, about the work the witnesses do and where it is best placed. I would like to hear the witnesses’ responses about where that work should sit in the system of services. Is í sin ceist uimhir a haon.
My second question is particularly directed to Mr. Andy O’Hara and the work in Uisce. The lads in Uisce did a fabulous job with the Sean O’Casey festival when I saw them two weeks ago. In the context of the stigma and all the other issues, I wish to hear a little bit about the GP services, the access piece and registration. I also wish to hear about the opioid stabilisation programme. We know that not every GP signed up.
With regard to the women attending Coolmine Therapeutic Community, the residential mother and child service, are they coming from homelessness? Are they lone parents? Who are they? That is in order for me to better understand because we need to make the case that it needs to be around the country. I have only left three minutes and 20 seconds for the responses. If I could hear back on those points, that would be great.
Mr. Andy O'Hara:
It goes back to looking at the people who are most marginalised, namely, people who use drugs and their families and communities. That is a collective. We have to have a strong infrastructure and framework because they are the people who will identify the emerging issues and gaps and then guide the collective responses. To answer the Deputy’s question around how we best identify where the gaps are, unless we are relying on that critical infrastructure, which is informed by national networks, we will always be at a loss. We will end up having another citizens’ assembly in ten years’ time and we will wonder how we got there. Going back to the Deputy’s question, there is evidence on all of the stuff we are saying here. There is international research. This is not the 1980s any more; we are not fumbling around. We have the research, evidence and models in this country but we have to trust in them and we have to share power.
The Deputy’s next question related to stigma in GPs and access to GPs. Stigma is massive and across the board. First, we have to understand how embedded in the system as a whole it is. It goes back to how we criminalise and stigmatise people because that informs people’s approach. They see people who use drugs as maybe less than them or that they have to decide for them. That leads to a harmful approach. This is why it is important to do advocacy. We have hundreds of advocacy cases and engagements where we know people are being discriminated against in GP settings. We know even around the country people cannot get into opioid agonist treatment, OAT, clinics because there are waiting lists. There are responses out there around nurses prescribing which are evidence based but they are not being implemented. Again, if you listen to people who use drugs, they will identify where the gaps are and we will be able to develop the collective response. It is about trusting people and believing in their agency to have power to be able to drive forward with the change.
Marie Sherlock (Dublin Central, Labour)
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Does anyone wish to answer the question on where family supports should sit in the system going forward in terms of the allocation and beefing up of funding?
Mr. Joe Slattery:
My perspective is to have a stand-alone service. To care for and support someone else’s recovery from addiction is a very different need. If you look at families impacted, you are talking about complex grief, trauma, abuse and all these things. It is great when a person goes into recovery. You are worrying when they are using and you are worrying when they are not. When they come out, you are tippy-toeing around and it is all about aiding the person’s recovery, which is really important. I am an addiction councillor by the way so I am not anti-drug users. From a family perspective, however, they are left with that trauma and PTSD of what happened when that person was in addiction, such as the fear of windows being smashed or the person coming in and doing something. That requires a stand-alone, unique intervention for them. Often, in communities in poverty, there is generational trauma where the parents bring that through and sometimes it ripples into the next person who ends up in addiction and so on and so forth. They need their own space to work through all that stuff. It should never be connected to anything else.
Gary Gannon (Dublin Central, Social Democrats)
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I am conscious that Senator Black has her hand up to answer the question also.
Frances Black (Independent)
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I thank Deputy Sherlock for the question. I agree with Mr. Slattery. There has to be a stand-alone service for family members for their own separate recovery because, as others have said, addiction impacts the whole family in a devastating way. It is really important that the recognition for family support and family therapy is part of the comprehensive public health approach in Ireland. The reality is that family members are devastated watching someone they love go down that self-destructive route. It can bring them into a very dark place. It is important that is recognised. It is about investment in help. Often, in a typical family of parents and children, for example, if one family member is lost in problematic alcohol, drug or even gambling use and in a very dark place, if he or she recovers, it can really impact the children and even sometimes break the legacy of addiction.
Such a stand-alone service is really important. I know all of the services here today do that, which is fantastic. FASN does really phenomenal work in the north east with regard to its family supports. There definitely has to be a stand-alone service for family members.
Marie Sherlock (Dublin Central, Labour)
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I do not want to eat into anyone else's time, so whatever the Chair wants to do.
Gary Gannon (Dublin Central, Social Democrats)
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I am conscious that I have cut the representatives from Coolmine Therapeutic Community off twice. I do not want to get a reputation for doing that a third time. Would one of its representatives like to answer the question?
Ms Anita Harris:
I will answer, although Suzanne probably is the best person to answer this, but just to state that there should be no profile. Coolmine is now unfortunately at a point where we are looking at those who are most at risk. We are having to go through assessments. What it is falling down to is what children are most at risk of going into care and which parent is most at risk. We have 24 women with children waiting on a bed in a mother and child facility today. They will never get a bed. We look for alternatives but there are no community alternatives that provide additional childcare. We will more than likely hear that their children have ended up in the care system and the women's substance use will get dramatically worse. I will let Ms Tackaberry answer the who's who question.
Ms Suzanne Tackaberry:
The term "addiction does not discriminate" comes to mind because of my experiences in Ashleigh House. We had professionals, solicitors and midwives. We also had mothers who were lone parents and mothers who were not lone parents. They had husbands, families and homes. There was a wide variety of women during my time in Ashleigh House. For me, addiction does not discriminate.
Colm Burke (Cork North-Central, Fine Gael)
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I thank all of the witnesses for their presentations. I know every one of the people in the organisations the witnesses work for work extremely hard and are dedicated to the jobs they do. I visited about 25 support services over the past two years. It has been a huge education for me as regards the work that is being done. As Ms Harris referred to earlier, the big issue is the impact of addiction on families. What can we do? There is a whole education process there but there is also the need for supports for families. How can we grow and co-ordinate these supports?
I visited seven different facilities in Limerick. They were all doing a very good job but were all independent. I wonder if we can do a lot more to co-ordinate the different groups? They all have a part to play and they are very important parts.
Ms Anita Harris:
The biggest issue with addiction services and children is that they lie between two Departments. We have the Department of children and the Department of Health. The best way to manage it would be to get the two Departments to co-ordinate at policy level. One policy is conflicting with other policies. The Hidden Harm statement provided a framework and foundation for addiction services but unfortunately it simply was not enough. It delivered training on recognising and identifying harm of parents, assuming there is a linear relationship between substance misuse and bad parenting. The training involved identifying risk, which is really important and absolutely vital for addiction services. There has, however, been what is called a double silence. This is where a parent does not talk about their substance misuse and the child understands not to talk about their parent's substance misuse. We now have a triple silence because addiction services are quite apprehensive and hesitant to ask parents about their substance misuse or their children. To me, and everyone here who works in the sector, this is causing a lot more harm than what it was intended to help with.
Ms Cindy Barry:
In terms of Deputy Burke's question about how can we co-ordinate family support, it is important to highlight that organisations like ourselves were born out of there being no services available for families. They had to build themselves up from the ground up. We are specifically peer led. Everybody in our organisation has experience of addiction in the family. Not all family support has that across the board.
In terms of joined-up policy, that is where we need the support of the Government to step in because we built this up and are trying to fund it ourselves. The need for our services is growing more and more and we need to come together more in committees like this to discuss it. Our group - which is alone in the north east - does not have answers on how to spread this nationally but we do recognise that it is needed.
Colm Burke (Cork North-Central, Fine Gael)
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It is not only about the witnesses' organisations but also about the likes of the health service, Tusla and the local authorities working a lot more and giving support so that there is that coordinated approach.
Ms Cindy Barry:
We do a lot of referrals. All of those agencies are coming together to respond to drug-debt intimidation as part of the DRIVE project. We are getting the same training and delivering it. We are taking a more joined-up approach and some funding was given to the DRIVE project to find an answer to drug-debt intimidation. As others have highlighted, there are a lot of different issues that we try and offer support for through our family support groups, including the educational programmes. How we do that across the board is maybe a question we may not be able to answer.
Colm Burke (Cork North-Central, Fine Gael)
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Another issue that occurs is when someone comes out of prison. I am not sure we have done enough when it comes to providing supports - even before they come out - to make sure they go down a different road to the road they were travelling,
Mr. Andy O'Hara:
It is a good point and goes back to the earlier point on what is the best way to respond. When we look at drug-related deaths, it is important to recognise the statistics of who they are. It is primarily people from particular backgrounds who are over represented. It is about implementing a social determinants approach around housing, educational attainment and job opportunities, both as a preventative measure and as an intervention later on. Those same interventions will divert people away from harmful activities when they come out of prison.
Mr. Michael Mason:
One of the things that happened when the National Family Support Network went into liquidation was that people in the family support sector, such as representatives from organisations like FASN and the South East Regional Family Support Network, came together very quickly. It is possible for a co-ordinated approach. That was where FARI came from as well. People who had that lived experience and service providers came together very quickly to organise. It needs a national organisation because, as Ms Barry mentioned, it is very hard for them to do stuff with little support in their own area never mind on a national basis. It needs a national organisation to link in with all the different services including the residential services, the community services, the stand-alone family services and also the peer support services. It is really important.
Máire Devine (Dublin South Central, Sinn Fein)
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I met some of the witnesses when Deputy Graves had the recovery month event last week or the week before. It was related to the very positive idea that recovery is possible. We often get bogged down in such negativity and I think that sometimes adds to the stigma. The witnesses are grappling for services all the time and they all seem to carry a heavy load. I also thank them for their presentations.
I want to concentrate on women in addiction. Being the Sinn Féin spokesperson for domestic and gender-based violence, I am very aware that vulnerable women in addiction are more likely to be subjected to violence and coercive control. Is there a project or a specific programme to approach this? Women are often kept in addiction or their children suffer because their male partner has the propensity to own them in some way.
That is like a lot of other women who experience it but this is a lot more concentrated in that they are in addiction, really dependent on that and are kept in that. How is that barrier broken? It is difficult enough to break the barrier and have women speak out about what is happening at home behind closed doors but especially in that situation. It is not just behind closed doors. There is also street violence for women who seem to be addicts as well. They are targets. Could the witnesses make a comment on that and the children who are caught up in that as well.
I want to talk about Hidden Harm, which came out in 2019. It was kind of a breakthrough at the time and we kind of figured it out. I have been a psychiatric nurse for most of my life so when that came out I was like wow, we have seen this and it is great to have it down on paper to begin to address what is happening with children who are alienated and feel left out, who have never felt held or secure in the world they were born into. Yesterday, we had some DEIS schools at the disability committee. They were talking about the difficulties of SNAs and the difficulties of home outreach where they actually go out to the home and get the child dressed. The child is so happy to see the home liaison officer because of the chaotic household they come from. It gives them four to five hours of normality and somebody minding them, taking care of them and somebody dressing them.
In certain circumstances, having children is a protective factor against relapse but mostly, it is not. It does not hold true for a significant length of time and so, despite the good intention, that child is left in what becomes intergenerational problematic stuff. Is there anything else we can do? Obviously, there are a load of spaces needed for mothers and babies but is there anything else that could be done in liaison with the education system because that is where they are actually getting stability in their lives as well? I thank the witnesses for the work they do. It is so needed.
Ms Annmarie Dunphy:
For women who use drugs and especially mothers who use drugs, they are completed isolated away. It is like they are invisible and their voices are not being heard. To be honest, I was like that myself until I came to Uisce and it gave me the opportunity to find my voice and speak out for other mothers in addiction as well. There are no services. I am from the midlands and I have to travel up to Dublin to Uisce. We are advocating and out there daily with outreach and advocating for women who are in addiction. All they need is support. They are being punished for speaking up but if they had those supports in place and had a wrap-around service, it would be a lot better for them to try to recover and heal.
Punishing them is causing generational trauma. That is what we need to stop and it spills into our families, our children, our community and everyone. There needs to be more supports in place. Women are afraid to speak out incase their kids will be taken and they will be stigmatised, which they are. Something needs to change because what we are doing now is not working.
Ms Anita Harris:
In terms of how we talk about families and children, we need to accept the reality that there are no services. As I said, there are two mothers and children - you could count them on one hand - coming into base services that actually provide services for mothers with their children. There is zero for fathers. Even that in itself shows it; there is absolutely nothing in existence for fathers with their children. We have a fantastic national drug rehabilitation framework that actually outlines and explains that four-tier model of care. We cannot integrate what is not there. Unfortunately, many mothers are fully hidden.
We talked about stigma earlier and we need to acknowledge it in policy. We think stigma and addiction is bad. For a woman, it is even worse and if you add pregnancy and motherhood to that, it actually compounds. We wonder why people remain hidden because even if they were not hidden, there is no service that exists to provide that service. There is a big group of people we are not thinking of here; children have their own needs. We may have some services that provide childcare separately for the child but there is no overlap with the service that is provided for the parent. There are two people who are treated very differently and there is absolutely no overlap. There are wonderful parenting programmes. One of them is the Parents Under Pressure programme that is delivered. Most of these programmes are geographical. If there is a really active CHO area, it will fund a very specific programme. It could be specified to Dublin north only. It cannot serve people in Dublin south because it is not within their funding.
We have programmes like the Parents Under Pressure that recognises there are parents living in the community who just need support. They need wrap-around supports. I have worked with women for my whole career. Addiction is the least of our problems. When they come in, we look at substance use and say no wonder they are using substances. There is domestic violence, homelessness and trauma. We cannot ignore that.
Ms Aileen Malone:
It was asked if there is something the Department of education can do. It occurs to me that we are linking children with women who are in addiction and who have already sought help. What about all those hundreds of thousands of children out there whose parents are not seeking help? After school clubs are something we do not provide here in Ireland very often. If we have somewhere for children to go after school, where they can be minded, get a hot meal, take part in activities and where there are stable adults to keep an eye on them, that helps us identify children who are at risk and then may be helped. Breakfast clubs could be something else as well.
Ann Graves (Dublin Fingal East, Sinn Fein)
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I think I have met many of the witnesses and visited many of their services over the last couple of months. The only way we really know what is happening on the ground is by doing that, along with today's meeting. I welcome all our witnesses. An Teachta Devine mentioned the recovery event last week and many here participated in it, which was a really positive event. What was most important, and it has been brought up here today, was for us to listen to the lived experience of the people who spoke. I have read through all of the presentations today in detail. I will only ask a few, generic questions.
From meeting the witnesses and their presentations today, what struck me is how important family support and peer support groups are to recovery. That should be central to any policy and the strategy that is forthcoming. The State cannot hand-pick individuals with lived experience that it finds palatable, as I think Mr. O'Hara said, and I 100% agree with him - it might have been Mr. Slattery. That is true right across the board. The voices of those affected by drug use need to be listened to and also considered as part of the strategy and the work of this group.
A lot of the visits I have been on and the feedback I am getting from groups, even from here today, is about funding. Unfortunately, we do not have a role in funding and we will not be making a presentation on the budget next week. I have advocated in the Dáil for multi-annual budgets for everybody and we may include something in the final report but we will not be looking for money in the budget. We cannot and it is not part of our remit. That is just something to be conscious of. In that vein, I want to hear from all the witnesses or anybody who wants to speak on it about how this committee can support their work and ensure their experience is reflected in policy. At the end of the day, that is what will change things. It will be policy driven and I am a firm believer in practice to policy, where the experience of the projects and the people the witnesses work with is reflected in Government policy and practice. That is how we will improve things from the point of view of this Government.
What can we do to get you involved in policy development? How can we ensure that services are delivered outside the Dublin area? This is something that has come up quite broadly. There is a huge number of groups where there is really nothing available for people who are suffering. The idea that drugs only exist in Dublin is crazy. Every single village and town is affected. Finally, on women in addiction, how can we encourage and improve their access to services? Many of them will not or cannot go because they are afraid their kids will be taken off them if they access services. In other cases, they are shoved into prostitution to raise money, maybe for a family member, to feed their habit. Those are three brief questions. I could have a hundred more. If any of our guests want to contact my office, please, feel free to do so.
Mr. Andy O'Hara:
What the committee has heard today is families and people who use drugs telling it what works. We know from our outreach and working with the families. We have far higher engagement than other groups because we are autonomous and peer-led. We know what is going on across the country, anywhere we are. It is the same with the families. If we think back to when the drugs task forces were first developed, there was a recognition of all these groups that are marginalised and excluded, people who use drugs, families and communities, and they need a community development approach, which we need to fund. We need to mandate that there are independent, autonomous peer networks for people who use drugs, for families and communities. They work in partnership with the State. If that is ad hoc, tokenistic or someone is deciding whether you get funding, or if you say something it gets pulled back, it will never work. It has to be agreed and it has to be mandated. To be fair, it is what all the evidence says about civil society and how autonomous peer networks work. If we want to do this, there is a very clear way to it. I am conscious Ms Dunphy might want to say something about women, families and giving women a voice.
Ms Annmarie Dunphy:
Women are afraid to access services because their children will be taken. A lot of it is the stigma that comes with it as well. Some of them are coming from domestic violence relationships. They are finding it very hard to trust people they do not know. That is where our peer outreach comes in. We are able to get to women who are afraid to speak out. We are able to be their voice. They have that trust in us to go back to Andy with the issue and set up advocacy cases that way, knowing they are not going to be reported to Tusla and their kids are not going to be taken, they are going to have the opportunity and chance to do what they have to do to keep their kids.
Mr. Andy O'Hara:
Again, it is getting people to be directly involved. In Uisce we have a peer partnership for change framework model. The goal is the achievement of social change. There is a participation spectrum and model that we implement to make sure people themselves are identifying issues and they are the ones speaking on them. It is not just me or Annmarie, and it is not just people who are in recovery. It is everybody. There is not a condition that you have to be drug-free to a certain level. You have human rights and you have a right to participate now and have a voice now. You have a right to deliver that message yourself directly to policy makers.
Mr. Joe Slattery:
Anyone who has done any addiction course will go through all the policies that were made since the 1980s. Ireland has really good policies. They are never acted on. What we can do is hold people accountable for what has been documented as the best way forward for people and families in addiction, and make sure they follow through on those actions. If they do not, as they have not since the 1980s, people need to be made accountable. That is what you can do.
Evanne Ní Chuilinn (Fine Gael)
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I am afraid I will miss the second round, so I want to have the witnesses take most of my five minutes where possible. The Parents Under Pressure programme is brilliant. Everybody has mentioned family support. Is that something that could be rolled out nationally by all of the various groups that are doing really good work for families?
Ms Anita Harris:
The Parents Under Pressure programme was taken into Coolmine in 2014. It is an Australian mode. When we rolled that out across Coolmine programmes, there was such a demand, with people asking if they needed to go to Coolmine or be in addiction to get this model, or does it applies to people in situations of domestic violence, or in a mental health context or to parents under pressure. The answer is yes. It was specifically designed for parents with substance misuse but also for kinship carers, grandparents who are now raising the children. In Australia, this was developed when there was a whole missing generation of parents in certain areas and it was the grandparents who were raising many of the children. At the moment there are over 400 trained PUP practitioners across Ireland, over the last two years.
Evanne Ní Chuilinn (Fine Gael)
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Are they all actually delivering the programme or are they just trained up?
Ms Anita Harris:
They are all external to Coolmine, so these are Tusla, social care workers, family support workers, family hubs. Again, it is not consistent, and depends on the task force in the area and if they place importance on it and decide to train a number of their people. There are some areas in Ireland that have lots of people trained in the PUP approach but other parts that have zero. It is not a consistent support or a consistent approach but it absolutely is a framework where people are hesitant when working with a hidden harm. Where services are very hesitant in asking should they work with the child, or the parent, or how to do it, this is a framework that will show them how to work with both.
Evanne Ní Chuilinn (Fine Gael)
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I have met people who have gone through the Parents Under Pressure programme. If we are trying to raise awareness of it or roll it out in some way, I presume there is an evidence base around positive outcomes. Can Ms Harris tell us a little bit about the outcomes?
Ms Anita Harris:
We do. There is a large evidence repository of randomised control trials all over the world. When it was brought to Ireland in 2014, Dr. Jo-Hanna Ivers in Trinity College carried out research to see if it would work in an Irish context, with an Irish cultural aspect to it. It absolutely does. The evidence indicated significant differences in lower levels of depression, anxiety and stress, increased levels of confidence and quality of care given. What is central to the Parents Under Pressure programme is the recognition that in order to support the child, you have to support the parent. The parent can be that person. It involves actually being able to measure capacity to change, so following doing some work with parents, if they do not have capacity to change, actually making decisions about whether the child might need an alternative carer for a period, or concluding that the parent does have full capacity but has so many stresses and pressures. It is an active case management model that now establishes what supports need to be put in place, what is available and advocates for them when they are not available.
People mentioned earlier the after-school clubs and the home liaison. They are specified to some areas. We need to recognise that communities have changed. Many years ago there were disadvantaged areas; I came from one and I know it is no longer disadvantaged. It is still considered to be disadvantaged but elements of that area are actually really highly privileged people because they have started building around these areas. Even when we talk about community now, and I am delighted Deputy Graves said it there, most people from Dublin have moved outside of Dublin because they cannot afford Dublin. The urban boundary has been expanded, with zero services. Every county in Ireland is affected by substance misuse. A lot of services that are trained with Parents Under Pressure are in specific areas but why should somebody from Cavan or Leitrim not be able to avail of it? Why should they have to go to Dublin?
Frances Black (Independent)
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I am only picking up some of the questions. I was very interested in Senator Ní Chuilinn's questions about the model. RISE is an online programme where we have a one to one service. We have a ten-week family programme and an aftercare programme. That model works very well when working with FASN in the north east, or any of the other family addiction support networks and peer to peer support groups. We have a team of eight therapists who are trained up specifically in the impact on family and working with that person individually. FASN would refer family members to RISE and they would come to our ten-week family programme. It is all online. We have three family programmes running at the moment, where 12 individuals come to us and they are in crisis, as other speakers have said. They do the ten-week family programme and then we refer back to others.
We also do a lot of surveys. For example, there was one on our new crisis intervention ten-week counselling service. We also do surveys on our family programmes. It is all evidence based. The recent report summarised it. It was a survey conducted with family members after completing ten counselling sessions. It highlighted the positive impacts on their mental health, coping strategies, awareness and overall well-being after ten weeks. We were not sure ten weeks were enough for the family members but they were.
The survey was designed to measure changes in the client's perspectives and behaviours as a result of the counselling process and we were amazed at the results we got. Before counselling, feelings of despair and hopelessness were prevalent with over 56% feeling lost, in trauma and with no real support. After counselling, feelings of despair and hopelessness decreased dramatically. I think 36.8% said they did not feel that any more or hardly at all. The extra supports and understanding were significant. I think 47% were feeling supported most of the time. The feelings of confusion and trauma were also reduced.
There is a huge benefit to the pre and post surveys we do with our family programmes, as well as our ten-week counselling programme. We hope to be evidence-based with our aftercare as well. Some family members come in, do the one-to-one counselling and then we refer them on to the ten-week family programme. The aftercare is the real work. When we refer them back to the Family Addiction Support Network, the family member has gone through an intense therapeutic process with the ten-week programme and then goes back into a peer-to-peer group in the network. The model works very well and we hope to expand that to other services and get a meeting with the south east regional family addiction support network as well. We are seeing unbelievable results. I am sure FASN can say a little about how the model works as well.
Gary Gannon (Dublin Central, Social Democrats)
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I thank the Senator. I am conscious Senator Ní Chuilinn was very good and asked two direct questions.
Evanne Ní Chuilinn (Fine Gael)
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I have one more. It relates to the statement earlier about addiction not discriminating or picking its victim. My question is about family support. I speak having seen my younger brother go through addiction for 15 years. We lost him to suicide, so it was not a happy ending. I am not from Dublin or a disadvantaged area. Are the witnesses seeing family members accessing facilities and supports from all walks of life and from across the country? I am from Kilkenny so refer particularly to the south east. Are the witnesses seeing it from all walks of life and all corners of society?
Ms Cindy Barry:
That is the exact statement. It does not discriminate. I do not like to put people in different boxes but it is from everybody - all parents and family members. It does not matter what walk of life. There are family members who might have people in prison, professional people and young people getting caught up in drug debt. We have everybody and anybody contacting us, mostly parents and sometimes grandparents who have to take over the care of their grandchildren because their son or daughter is in addiction. I could sit here and write a book about the different realms of people. It does not discriminate. Everybody is trying to step forward for help.
We have families coming forward who do not have loved ones in treatment. We have a lot of HRB statistics on people in treatment and that can link into family members. I want to speak about that, though I know I am going off course a bit. In the HRB, where statistics are gathered about people in addiction, there is not enough space given to gathering information about families. We work with families and can give detailed cases. We collect it all in-house but it is not fed into the HRB because the HRB does not allow us to put in the details on behalf of family members. Committee members could be given information on the issues family face, whether mental health, dual diagnosis or debt intimidation. However, the place is not there for us to feed in to let people know exactly what families are facing on the ground. It is only when we have meetings like this and are asked directly about what families from all walks of life are experiencing that members get to hear that and policy can be made around that. Does that make sense?
Gary Gannon (Dublin Central, Social Democrats)
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Sorry, I want to make sure all members get to ask their questions. Then we will come back at the end to make sure the witnesses are heard more. I move on to the distinguished guest of the committee, Deputy Ó Murchú.
Ruairí Ó Murchú (Louth, Sinn Fein)
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Go raibh maith agat, a Chathaoirligh. Cuirim fáilte roimh na finnéithe go léir. I would be a long time name-checking everyone that is here. The witnesses have laid it out straightforwardly. Mr. Slattery and Mr. O'Hara have spoken about everybody knowing what to do here. The best practice is known but has not ever been implemented to any degree. Ms Harris made the point about where there is no service if you are talking about women in addiction. Ms Dunphy also spoke in relation to that.
We need to make sure there is a strategy, and a strategy means a plan. We all talk about multi-agency but we all know Departments do not talk to one another. When they do, it is sometimes only to say "That is not my responsibility."
A big welcome to Ms Barry and Ms McKenna. FASN operates out of Dundalk and does a huge amount of work. I have been at a number of fundraisers it has done and half the time the fundraisers are organised by guards. FASN still has Christy Mangan on its board. He is a former chief superintendent. That was on the basis that FASN provided a family support system which members of the Garda were not capable of providing but saw as being necessary. I ask representatives to detail the low cost of their operations and how they have constantly fallen between the Departments of health and justice. We all talk of the need for multi-annual funding and we have seen the corporatisation of how the State operates and who it engages with. While we all want to see best practice and governance, sometimes we lose the community dimension.
Most of the organisations represented here were built on the basis of need because the State was not meeting that need. The biggest point made was that a network was formed but what is really needed is for the State to provide a strategy for family addiction supports and, beyond that, to facilitate a network of those that are there. I ask the witnesses to make their own case.
Ms Gwen McKenna:
I think 1997 was when addiction rose its head in Cavan. We went looking for help but could not get any. There were no services and we were not even referred to Al-Anon or any place like that. We had never heard of it at that stage. We came to Dublin. They were doing the marches at that time in Dublin. We met up with like-minded people who were our lifesavers and helped us to do that. All our services developed because of the people in need. When they come to us, we listen to what they have to say and what they need in the region and then we do our best to supply those services. We have a wonderful board of management and brilliant staff. We have 15 change facilitators who have come through the peer support groups and have the lived experience, as well as level 6 facilitation skills, conflict management and the five-step therapy. We are very cost-effective in the-----
Ms Gwen McKenna:
Value for money, that is it. At the heart of it all are the family members and what they go through. We do not see family members as victims but as people in their own right. They get support and education. We work with Frances. The CYPSCs fund us to deliver a programme. The ten-week programme is done at RISE.
In 2024, some 39 people went through the programme. When they come back they have made changes in their lives. They have discovered new things and come back into the peer support group. Everything goes back to the peer support group, because you can maintain your changes and live your life there. Through that, it is about giving back to the community.
The stigma is horrendous. Based on my own experience, I would have said, "Do not go down near that family, do not get in touch with them, do not be part of that at all," but when it came to my own doorstep it opened my eyes completely. Now we are the voices for the families in the north east but we cannot do this on our own. We do not do it on our own. We are linked in with FARI and all of the agencies in Dublin as well.
Gary Gannon (Dublin Central, Social Democrats)
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I thank Ms McKenna. Mr. O'Hara and then Mr. Mason are next.
Mr. Michael Mason:
It is really, really important there is one element that has kind of been left out and that is lived experience and the voice of those with lived experience, whether that is families or service users and they are not, at the moment, at the policy level or the invitation level. We have been excluded from that and that needs to be implemented as well. It was mentioned at the very beginning that the committee would have a report in nine months and there is talk about a new national drug strategy that is coming in less than six months now. There is no input from those with lived exeprience whether from families or from people who use drugs. They are not in there as part of it and that it really important.
PUP, Parents Under Pressure, is an absolutely fantastic programme. There are other evidence-based programmes run right around the country, whether it is five step, CRAFT, and lots of different ones. There are ones that Senator Black, in the RISE Foundation, runs. There are programmes that Mr. Slattery runs in Limerick. However, it is all post-coded. A question was asked there whether we are seeing people from every part of society. We are. Families need support and different families need different support. Different support needs to be available everywhere and that is really important. It cannot be post-coded. It has to be available right throughout the country and available to everyone.
Gary Gannon (Dublin Central, Social Democrats)
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I thank you Mr. Mason. I imagine Mr. O'Hara has something to say on that as well.
Mr. Andy O'Hara:
As Mr. Mason said, it is a geographical option at the minute. I wish to clarify and reframe something, as has been set out here. Most of our actions and understandings are based on a moral crusade against people who use drugs and the families they come from. We end up punishing people when we see them as the problem. We need to shift that narrative. We have heard today, and the evidence shows, that people who use drugs, and their families, are the solution and they have a structural analysis nobody else has. It is what the system is crying out for. We need to build the response and the solutions around that.
I will go back to some of the things that have been mentioned. Stigma is unbelievable and it goes across all classes. I refer to the number of people who are not speaking up, having a voice or getting the support they can get is because of stigma. We did a piece with FARI and went back to the peers and asked them if they wanted to do a piece of work for the national event, and they said, "Yeah, definitely." One person said something I thought was powerful. He said, "When we had no voice and were dying in our droves in the 80s and 90s, it was the mas who stood up, it was the mas who marched the streets, it was the mas who demanded the services and that is why we are where we are." It is about asking ourselves why we are still seeing the high level of deaths and harm and people who use drugs and their families are still saying they are not being listened to. We have what we need in terms of the networks that are there. We need to just build stuff around that and rely on that.
Gary Gannon (Dublin Central, Social Democrats)
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I am next in the slot but I am also conscious of the patience of Senator Ryan and Deputy Sherlock. If they would like to ask some questions first I think I will have time to ask mine at the end.
Nicole Ryan (Sinn Fein)
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My question is open to everyone and is around tokenism the national drug strategy. I worked in drug services which were "nice" - they were the standard drug services - and nothing could have prepared me for working in a low-threshold, homeless service and how different that was. I was working with groups who were migrants or from the Traveller community and seeing the shift of how the gardaí and services outside of that would treat them. We were not saying that we had input from all types of groups and stuff like that but sometimes groups like that are almost a token, box-ticking thing to say, "Right, we have talked to them, that is grand, that is covered." How, in the national drug strategy and even in our own work and what informs us, could we ensure it is not just tokenism and that there is governance around that and that their lived experiences are embedded into this?
Mr. Andy O'Hara:
We have a toolkit on that. It is about the most marginalised. Remember, drugs are across all classes and all parts of society but if we look to the overwhelming harm being caused, it is all of the marginalised groups who have experienced trauma, who have had a lack of opportunities, who take drugs to cope and then are punished and criminalised for taking drugs to cope. Then they arrive into the services and structures and are punished further because of the lack of understanding about where they come from. It is about having a structured approach to how we engage with those groups. It is not an add-on. Our toolkit is very clear about it. It is principles and values, process and task and making sure people who use drugs are part of the design, delivery and evaluation of everything.
An example of that would be the research. That was done specifically by people who were drug-dependent and who were currently in emergency accommodation. They did a living experience analysis of the services from a human rights framework. What they were able to do then was give an overall view of what the system is but then, more importantly, come up with solutions. What we see in our services is, when we start with, not the drug use and we will give people agency, a voice and some power and they will gave value and ownership. What happens is, normally, people progress through that. A lot of people may decide, "I might address my drug use, I might take less drugs", because once you give people ownership, value and a role in something bigger that is beyond just themselves then we can deal with all of the other stuff. There has to be a very targeted approach and very structured process to engage with those groups.
Nicole Ryan (Sinn Fein)
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Thank is great and I thank Mr. O'Hara. I feel that sometimes it is a criterion for services to be quite rigid when there is drug use. People who use substances come from all walks of life and it is all people.
Mr. Andy O'Hara:
It is just worth adding what can happen. We need to be careful around peer work. Everyone wants to do peer work but if it is completely service-led and State-led we can get peers in, peers think they will go in to be the voice of their peers and represent them, but it can be structurally set against them. Then sometimes the peers end up just being the voice of the service or there to promote the service, which is a different role though it might be animportant role. We have to be very clear about what we are defining and what we are doing because we can not only be tokenistic but we can actually create more harm.
Mr. Joe Slattery:
Another thing to consider is the lack of training in all aspects of the addiction field. Social workers do very little on addiction during their training. Doctors do very little. Members of the Garda do none. I am lucky enough to be part of the DRIVE, drug related intimidation and violence engagement, oversight committee for drug intimidation and part of the implementation of that is that gardaí will be trained in Templemore on drug debt intimidation. That is part of one of our suggestions. There was no training done on trauma, or understanding addiction so to this day, everyone is still treated as a criminal. Then we have unique people with unique empathy who will do it differently but as far as the system goes, people are still treated as criminals. That is due to a lack of understanding and education. That needs to be resolved if we want to get people to come to our door instead of being shamed and not coming back. Part of this is that the system is wrong.
Gary Gannon (Dublin Central, Social Democrats)
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Does that remind the Senator of another question?
Nicole Ryan (Sinn Fein)
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No, those were fantastic contributions. I thank the witnesses.
Marie Sherlock (Dublin Central, Labour)
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Does the Chair not want to go ahead and I can come back in?
Gary Gannon (Dublin Central, Social Democrats)
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No, I am positive.
Marie Sherlock (Dublin Central, Labour)
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First, to clarify something I said earlier that might have come across rather clumsily, I am really conscious addiction does not discriminate. My question earlier was about the circumstances upon which a woman would need to go into a service with her children and I did not mean to get into profiling but just wanted to understand why. The question was addressed with regard to risk. I want to be clear about that, that I did not mean in any to offend or anything like that.
I am particularly interested in hearing about the relationships between the family support organisations and local authorities. Mr. Slattery spoke very powerfully about we do not have the training hardwired into the Garda with regard to trauma, drug related intimidation and all of that. Obviously, the DRIVE programme is there now. With regard to councils in terms of the housing aspect, when that intimidation is taking place, I would like to hear what relationships the witnesses have with local authorities in their various areas.
Ms Cindy Barry:
In regard to training, I delivered some DRIVE training last Friday to front-line workers.
A lot of the county councils come to that, and especially people from the housing departments, because they have people coming in to them who are experiencing intimidation. They were very eager to learn and delighted that the DRIVE project is in place. I think there is a kind of a sigh of relief among a lot of us as front-line workers that something is bringing us together in terms of having a more integrated and structured approach to work with this issue. We really have been working by ourselves, blindly and isolated in our different services for a long time. It is nearly the perfect opportunity in that training room for us to share our experience and to learn from each other. It was powerful to be honest. There is not enough of that. There are so many different areas in the county councils and the homeless services and everybody is trying to hold their own and manage in the sector. We do not have enough reasons to come together to share our experience and share resources or to know who to refer to. There is such a gap in Ireland where people do not know what is out there and they do not know about the community-based organisations. The DRIVE training gives us the perfect opportunity for coming forward and they are hungry for information. They want to help people. They want to understand and to refer to us. It was really positive.
Mr. Joe Slattery:
From the mid-west perspective it is really successful and it really highlights how the interagency model works. We have a TR meeting, which is a treatment and rehab meeting, quarterly. It has all the drugs services, including the funder, that is, the HSE, the housing services and counsellors. There could be gardaí there too. There is a body of people and we all network and know one another very well. Sometimes you can phone housing and say "Listen this is a desperate situation, do something", and they will but only if a house or bed is available. The relationship is really strong. We absolutely do not work in work in isolation in Limerick. Everyone works together. There are favours, and a sense of "let us work a little harder here", and there are insights. That treatment and rehab interagency model should be implemented all over this country. We come together outside the DRIVE every quarter just to check in and ask each other what are we highlighting, what are we seeing, what is happening on the streets, how are we responding to it, how can we help, is there an interagency piece or a collaboration piece or can we share funding on this training. That works really well and is a model that should be highlighted across the country.
Marie Sherlock (Dublin Central, Labour)
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That is great to hear because my own sense is that we do not have consistency across the country on that. We see different policies, for example with the band A exception on social grounds and the eligibility for that. There is a bit of chicken and egg here. Because there is so little supply the bar almost has to be set all the higher for the most extreme of cases. It is about the recognition that drug-related intimidation should very much be part of being seen as an exceptional social ground when a person is looking to transfer or access to housing. That is enough from me. I thank the Chair.
Colm Burke (Cork North-Central, Fine Gael)
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I apologise for being out there as I had other meetings to do. The discussion may already have touched on the growth in the availability of cocaine. What kind of percentage growth have we seen over the last two to three years, or even over the last five years? We must then consider the number of people adversely affected, for example in the area of heroin, at the moment. I signed the licence agreement for the Merchants Quay Project on 21 December 2024. It opened on 22 December. Between that date and 30 May there were some 4,000 attendances there. That is not 4,000 people, it is about 670 people who used the facilities in Merchant's Quay over the following five months. There has been a huge growth in cocaine use. How is that posing new challenges that were not there five years ago? Would any of the witnesses like to deal with that?
Ms Anita Harris:
There has absolutely been a significant increase in those presenting for treatment for cocaine. What is really important, however, and it keeps getting drowned out in most media, is that alcohol remains the substance for which the largest numbers of people seek treatment. We have 18 services across Ireland. Cocaine is the drug with highest use, but actually alcohol use is dominating every service across the board. When the national drug treatment reporting system, NDTRS, and the Health Research Board separated out alcohol and the drug treatment presentations this created a distortion in the numbers where it looks like cocaine is actually dominating across, but alcohol remains the biggest. Sometimes we as services need to not get too reactionary or react in all our services to address the cocaine needs when alcohol is still the dominant substance for which people seek treatment.
The HSE got very active, and I was really impressed at how activated they became with the surge in cocaine use. Cocaine treatment programmes were initiated right across the country. Funding became available to most counties. Interestingly, it was a drug that absolutely did not discriminate. It went across every region, every county, every age and every gender. There was a really rapid response for services to then address the needs of that cocaine use. We must not forget, however, that there are other substances. I keep hearing that opiate users are ageing out and there will not be any, but we still see plenty of opiate users. I look at how many people are still in receipt of methadone. This tells us that the opiate users are still there. We just need to be careful as service providers that we do not start moving our services to just respond to one drug only.
Mr. Andy O'Hara:
It is really the type of use also. Cocaine use has massively increased and crack cocaine has massively increased but people taking multiple drugs is very prevalent. This could be alcohol, cocaine, tablets, crack cocaine, heroin, or crystal meth. We must be conscious there are multiple drugs and a never-ending supply of new drugs coming onto the market all the time. We need to be conscious of how we respond collectively to all those drugs and how informed we are on drug checking. We must also understand that there are underlying conditions behind all this. There is a huge issue with crack cocaine across the country now. Most of them are people who probably would have been taking just heroin in the 1980s. They come from the same backgrounds, the same communities, with the same traumas. It is about trying to recognise and respond to the polydrug use and also really getting underneath and trying to address those underlying conditions for why taking the hardest of drugs is more prevalent among such people.
Colm Burke (Cork North-Central, Fine Gael)
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On the whole issue of education programmes around any substance abuse, is there a lot more we should be doing within our education system to highlight the risks that exist? Some people can take a drug and it does not have an adverse effect on them but other people can get addicted at a very early stage. What do the witnesses feel should be changed in this regard with the whole education programme?
Gary Gannon (Dublin Central, Social Democrats)
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I thank the Deputy. I see everyone nodding.
Ms Anita Harris:
With regard to the whole policy, when I look at national drugs strategy after national drugs strategy early intervention barely gets recognition. Realistically it should be a pillar all by itself. Earlier we spoke about parents who use drugs. Their kids are at the biggest risk. Where is the early intervention happening there? We can talk about general school approaches and going into schools. We just need to remember that any single person who uses drugs does not think they will become addicted. Regardless of whether they are 13, 14 or 15 years of age, many people who use drugs will not become addicted. It will be recreational drug use. They will start and they will finish and they will get on with their lives. There will, however, be that certain proportion, as Mr. O'Hara was saying, that all possess certain different characteristics such as coming from the same trauma or the same backgrounds. These are the children we need to target. There need to be targeted approaches. I mentioned the types of programmes for working specifically with parents who use substances. They are raising their kids and they use a substance. There needs to be targeted programmes looking at how do we get in at these parents to support them. That way we will support their kids instead of it becoming intergenerational. There is no denying the intergenerational cycle of addiction.
We carry out a lot of research at Coolmine. It consistently shows that in 80% to 90% of cases, one or both parents will have had addiction issues. We cannot ignore evidence that keeps circulating in this regard, so we really need to focus on the prevention.
Mary Fitzpatrick (Fianna Fail)
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My apologies for having to leave. I thank the witnesses sincerely for being here today and the work they do.
Mr. Slattery articulated very eloquently the impact and experience of a family member when somebody they love suffers from an addiction. It is horrific. I commend all the guests for the work they do on family support and in supporting people in addiction to move onto a road of recovery. It is incredibly important work and it is largely unseen. I acknowledge it and thank the guests for it.
I served in a voluntary capacity as a director of a family resource centre. When the guests talk about the challenges with funding and recognition as stakeholders, I get it. I support their call for adequate funding and proper recognition as stakeholders.
Unfortunately, I have been back and forth because we have had other meetings today and the Seanad is sitting. That is why I was not here, but all this is recorded and I have all the opening statements. I will be working with the rest of the committee, so please do not take my going in and out as my being in any way disrespectful. It is not intended that way at all.
I have some questions and I will put them to each organisation. On the new drug strategy, they very clearly called out the stigma issue. It is real and there is no doubt about that. There are models we could learn from and adopt. Prevention and early intervention are not focused on enough. That is a missed opportunity, and as a committee we have a real chance to strengthen this.
Mr. O’Hara very clearly called out the stigma issue. There is no doubt but that it is real. In society, there is a huge stigma attached to addiction. What suggestions, if any, are there in this regard? I am not asking for a magic-wand answer. Are there societies or jurisdictions with models we could learn from, suggest including and adopt?
Ms Harris mentioned prevention. Early intervention and prevention are just not focused on enough. This is a missed opportunity in this regard. As a committee, we have a genuine opportunity to put more emphasis here, while not detracting from doing so in other areas. If there is one thing the organisations believe we should be seeking to prioritise in terms of prevention and early intervention, I would love to hear from them about them. Mr. O’Hara might respond first.
Mr. Andy O'Hara:
Stigma is an important issue. I know from experience that when you move from being a recreational drug user to being dependent on hard drugs, everything changes. You become a pariah, something that is a problem. That is when people take harder drugs and more risks. You feel like you have nothing left to offer. Challenging stigma is important and valuable.
We produced peer-led research on how embedded stigma is across the systems. It is intersectional. This relates to how we criminalise people. We view people with a drug addiction, a gambling addiction or an alcohol addiction vastly differently. It is linked to how we criminalise them. The criminalisation approach, which stigmatises, becomes embedded across housing and healthcare, including mental health care. Our peers decided that what they really needed to do was research. They looked around and said some of the existing research was limited because it did not really highlight how structural the issue was. They highlighted the structural nature of it and from there developed a proposal to have a peer-led national campaign and peer-led training for all services, beginning at community and national levels, to unpack and drive a wedge through stigma. Stigma affects everyone, not just marginalised groups. Middle- and upper-class people may be affected. A GAA player who works in a bank is not going to go into his job tomorrow and then go home to his or her family and tell them he or she has an issue with drugs. No, he or she is probably going to wait until it escalates. Stigma affects everyone and what we need is a structured approach to unpack it and remove it from the system. That needs peer-led anti-stigma campaigns and peer-led training. It also requires a commitment to decriminalising people, because as long as we keep committing to criminalising people, we will be committing to causing undue harm.
Mary Fitzpatrick (Fianna Fail)
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I thank Mr. O’Hara. What about prevention and early intervention?
Mary Fitzpatrick (Fianna Fail)
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I am sorry but I did not realise the clock was an issue.
Mr. Joe Slattery:
The Senator referred to prevention and early intervention. These can happen only if a person feels safe enough to say there are problems at home and that they need help. It can happen only if the person they speak to is educated to understand trauma and poverty and that when a child flips over a table, it is just communication and does not warrant saying, “How dare you do that in my class.” The person should be able to see that there is a child in pain who is trying to say something is wrong. Prevention and early intervention are actually the task of the other person. If I have someone I can trust or who I feel understands me, loves me or wants me in their vicinity, there is a better chance I will stay safe. If I feel that I am a dirtbag, that I am regarded as a scumbag and that no one wants me and if I am told to get out the classroom, where am I going to go? I am going to go into myself and use drugs to make myself feel better. If we want prevention and early intervention, we must educate the people who are supposed to be the role models in our lives, even beyond our parents. It is a matter of the schoolteacher, community garda or whoever seeing you for what is really going on in your life as opposed to a problem that needs to be solved.
Ms Anita Harris:
That we all keep ignoring early intervention is why children are rarely mentioned, if ever, in any national drug strategy. I looked at two actions and all they referred to was hidden harm, identifying risk and mitigating the risk against children. That is the extent to which our current national drugs strategy addresses the issue of children. There is absolutely nothing else in this regard. We do not have any national protocols. We have two Departments that hold responsibility and we cannot escape that reality. At the moment, early intervention cannot happen because there are no clear national protocols. First, which Department holds the lead? There is no reason it cannot happen. Many years ago, good practice guidelines were developed for methadone prescribers and addiction recovery bodies. There was often conflict over how each side worked. Following work done together, national guidelines and good protocols were developed, whereby both sides were considered and there was agreement.
Where early intervention is concerned, people need to feel safe, as Mr. Slattery said. When we are talking, and we really need to, about why parents wait until the very end, when their backs are against the wall and they have lost nearly everything, before they seek treatment, we should realise it is because they are terrified their children will be removed. That this is occurring is not rational; it is irrational, and it is being compounded by policy every time. People talk about mandatory reporting where there is substance misuse. Where a parent is in question, there needs to be mandatory reporting. Andy and everybody else talked about the punitive element. We can never do prevention until somebody who feels they have an issue with alcohol or drugs can actually go to their primary healthcare centre or GP, under a health-led approach that regards them as having an illness like anybody else’s, and have a service provided. We need to recognise it is very rational for parents to be terrified to seek help.
Ann Graves (Dublin Fingal East, Sinn Fein)
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I thank all the witnesses for their contributions. One point I took from them was the lack of involvement of all the groups in the development of the new strategy. That has been raised. The chair and secretary of the Citizens’ Assembly on Drugs Use were here last week and their understanding was that everyone was supposed to have a voice. We will probably be following up on that.
I believe everything has been covered. I have a question for Mr. Slattery, on drug intimidation. It is great that we have the DRIVE programme and that it works very well, but how do we get people to buy into it? There are many cases in which people say such a thing is happening to them but they are absolutely terrified. With regard to housing, Ireland is a small country. If somebody moves from one house to another, they will be found. Where I am, Fingal, everybody knows everybody. Unless people are given a new identity and moved to a different country, which will not happen, this will be an issue. How do we address this?
I have had two cases which were very successfully brought through the courts. They really worked well. The only reason the people went ahead was because they had absolutely no choice. They did not have the wherewithal to borrow money. They literally had no choice but they won and the cases were successful. The vast majority of other people are borrowing money from credit unions, banks - you name it - to pay off drug debts. Have our guests any ideas about ways to encourage people?
Mr. Joe Slattery:
It is back to the State's capacity. The end result of DRIVE is not to bring everyone to court for drug debt intimidation. When a family is at home terrified and not knowing where to go, do not know how to process the pros and cons of decisions that they need to make but they can approach DRIVE and speak to someone who does, and will help them problem solve what they want to do next.
Obviously there is an influence between the guards. In some areas it works really well and sometimes it is others. We had a situation recently where an inspector came in. The person the inspector spoke to felt very relieved after speaking to him, with no obligation to do anything. After that, the inspector sent another person from his team to speak about preventative measures a person can take to make one's home feel safe. For example, people can move things around such as video cameras and do different things to feel safe while this is going on. That was a really good intervention. The people will be given the choice and asked whether or not they want to go forward with this. It makes no difference to me. The whole point is DRIVE is there to help people whereas before they were lost. One part of our training is to identify potential instances such as if a person is working in a credit union and I withdraw €10,000 and do the same a month later. The same with GAA clubs and all that. Cocaine is massive big money and users get into debt really quickly. DRIVE helps people to respond to that. A number of people will probably come in front of the courts and say that they want to do that while others will never, ever do that for the same reasons mentioned by the Deputy so let us offer them support.
Another aspect and real pillar of our work is the NDTRS and to get statistics. There are no statistics in this country on the level of drug debt intimidation but that has now been created. Once that is there and the evidence is in front of the Government and Garda, they will now have to respond. That is where it is at the moment. It is building those foundations to get a true reflection so money can be put into the proper areas. We do need to know where it goes.
Mr. Andy O'Hara:
In 2007, a book called Young People in Contemporary Ireland was published by Kevin Lawlor, Áine De Róiste and Maurice Devlin, which stated one very important thing, which was that young people want three things, namely, money, status and power. How a person acquires that in one area of Dublin or Limerick vastly differs. So we, as a society, need to go back to basics and ask why do we have a never-ending supply of young people who are willing to take the hardest of drugs and why do we have a never-ending supply of young people willing to sell drugs for economic opportunity. We now see an over-representation. It is to do with the housing crisis and a lack of opportunities.
Gary Gannon (Dublin Central, Social Democrats)
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Yes.
Mr. Andy O'Hara:
We are seeing more and more people come into emergency accommodation who never would have been in there heretofore. We are working with loads of young people. Most young people who take drugs will take drugs recreationally but they eventually will do a cost-benefit analysis, will never become drug dependent and move on with their lives. That happens when they get a home, a partner, have a family and get a job. It is different when those things become hard to get or young people cannot get them. Increasingly, we see people where their partner is having a baby and they have a job, she has a job but they cannot get a home so they end up in emergency accommodation, which means the father cannot see the children or new baby because they are being brought in. The longer those people are in that system then the more complex become their needs. These are people who would never have become drug dependent nor got involved in the criminal underworld but they are now getting involved. The social determinants and how we address the underlying issues are vital if we are going to have better outcomes for people.
Ms Aileen Malone:
Any of the people that I know who have faced drug-related intimidation have not gone to DRIVE. They do not know about it. People only hear of DRIVE if a person's loved one is availing of services or links in with services. Personally, I know people who have borrowed huge sums of money from their credit union to pay off debts. I know somebody who sold their house and is now living in a little shed in their other child's back garden. It is a huge problem.
We held a conference in Dundalk and that time 53% of people said that they were under extreme financial stress and suffering drug-related intimidation. There is a huge cohort of people and family members whose loved ones are not availing of services or not linking in with services and, therefore, they do not know about DRIVE. They do not know that there are supports and help available to them. So we are failing those people because always, and even with children, with families, we are tending to link the children and families with the person who is in addiction. However, unless the person who is in addiction is availing of services then those children and families are getting lost.
Ms Gwen McKenna:
Family Addiction Support Network, FASN, has family peer support groups and the family members answered a FASN questionnaire and we learned the following. About 85% of those families had paid debts and they said they never mentioned that they had paid debts because it has become normalised for them. So another perspective is that families have accepted that this is what they will have to do.
Gary Gannon (Dublin Central, Social Democrats)
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Yes.
Mr. Michael Mason:
People will not mention it to their own family that they are paying debts and going to credit unions. Shame and stigma are at the core of paying debts. Also, the person demanding to be paid could be their next door neighbour, depending on the area in which they live, which brings us back to postcodes.
Ruairí Ó Murchú (Louth, Sinn Fein)
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A lot of what I wanted to say has already been said. We have always had an issue with alcohol and we have never been serious around it. Cocaine crosses every strata but obviously it is the disadvantaged communities that suffer the most. I get the set-up has changed. However, the root cause still is poverty and multigenerational trauma. It is also a case of seeing the bad example. I mean when people know they are not necessarily going to be a Rhode scholar or whatever yet see someone operate as a dealer for ten or 15 years with no consequences. That is the perception and the issue. Taking into account family supports, what does a national drugs strategy look like?
On the Family Addiction Support Network, it not only provides supports. Again, there are people who are still afraid to go to the guards, particularly when they are dealing with drug debt intimidation and whatever. I have sent a number of people but it is an outfit that almost closed a number of times. We are not serious about having a conversation about addiction but we are also not serious about resourcing what needs to happen and putting a proper framework in place.
I will also say it like Mr. Slattery. I have gone to the guards multiple times about instances of drug debt intimidation. In terms of getting people over the fear factor, in some cases people have spit up and have not paid. Again, there are people who have paid once and on that basis somebody lets the dealer run up a tab again without realising the dealer was able to get a credit union loan or cash in a pension or something which they cannot do the next time, and then we have all seen places that have been burned out. The difference is that when a person goes to the guards is that at least one is putting somebody in highlights, not even in relation to drug dealing but in relation to violence, which I think is absolutely necessary but I would be afraid of my life that we are not going to have the framework that we need because I do not think we are addressing the current needs and requirements.
Mr. Andy O'Hara:
We trust them completely. Rightly, we are talking about a health-led response. It is not even just a health-led response. It is a social and health-led response. The national drugs strategy is always going to be limited. The following was said at the citizens' assembly, and named in the strategy stuff. This is a comprehensive national cross-departmental approach. We must have an approach that addresses all of the underlying issues of housing, education, employment opportunities and better communities and better futures. It is okay to have a national drugs strategy that mentions some of that but there will be no progress unless the strategy is linked into a broader housing policy. A lot of the problems that we are seeing now are linked back to the failed housing policy. So we are always trying to play catch-up and fill in the gaps. We need to have interventions and preventative measures but, going back to the structural analysis, we must do the following.
Listen to people who use drugs. Listen to families. Listen to communities. People know what the issues are. People have been saying what they are for 30 to 40 years. It is not rocket science. It came up in the citizens' assembly where there was a bit of a demoralised approach at times, like this was a wicked problem or some mad problem that cannot be fixed. There are solutions, and they are linked to poverty, power and the social determinants approach. If we do not address all of them and keep trying, we will never catch up. We will always have good interventions and responses. Plenty of them have been allowed out of it. We need to continue to have these. We need massive interventions, investment and funding in inner-city areas. In 40 years how about if we have fewer services or a decrease in services or responses?
Ruairí Ó Murchú (Louth, Sinn Fein)
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It would be cheaper in the long run.
Mr. Michael Mason:
The Deputy asked about the new national drug strategy. When the most recent one was reviewed, all the answers were in that. It spoke about collective inputs and the importance of embedding stakeholder voices, the lived experience within that and the continuous improvement of drug policy. It also talked about how community-led and peer-driven initiatives were highlighted as promising and promoting recovery and reducing stigma. It then talked about the inconsistency and the frequently underfunded implementation. We are again going back. The answers are in the last review. We need the voice there. The voice of the families was in the previous strategy. It was supposed to be part of the national oversight committee, NOC. Since the last national family support network closed, that voice has not been there for the last number of years. It needs to be back in. The lived experience has to be in there as part of the policy decisions and of the implementation. It is not just a matter of writing it. It has to be implemented.
Gary Gannon (Dublin Central, Social Democrats)
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We have gone full circle and I have not asked any questions. The witnesses have all given up their time and expertise, taken out of what are clearly busy days. Is there any question that has not been asked of them? Is there any point they were making that was interrupted? Is there anything of which they would like to make this committee aware before they leave?
Ms Yvonne Lyones:
One thing I did not hear mentioned was the isolation you feel. The isolation can be from your own family as well. When you go into the services you are able to express that because you cannot speak to your family. I have a son in cocaine addiction. People have gone to his job to tell him to get into a car and take his wages out. He never told them where he lived, thank God. My family would have isolated me and not spoken to me because I bailed him out, or else he could have been murdered. That is not being dramatic. They were drug dealers, and they were looking for their money. It is the isolation from your own family because they are not speaking to you. It is your son, who you gave birth to, and who you loved and hated at the same time because of what was happening. It is the isolation part of it. The services are there and are fantastic in the peer support groups. You do not feel isolated. There are many more people like yourself in there. Their families are treating them the same way, and isolating them, their own families.
Gary Gannon (Dublin Central, Social Democrats)
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Thank you, Ms Lyones, for sharing that experience.
Mr. Joe Slattery:
We did research last year. Quite a lot of it was to measure the complexities of the people who came in our door. They came in focusing on their loved one, but by the time they settled in and were going through the programme the focus becomes their own upbringing and stuff like that. There is a journey through the counselling. When we did the research, we went through the national drugs strategies looking for the definition of "complex needs" for families and there is none. There have never been any. We did our own research with an interagency group including participants and other services to come up with a layman's term for "complex needs" that should be put in the national drugs strategy. I have sent it to all of the members, and I would like them to review and consider putting it into this strategy.
Ms Cindy Barry:
I echo what people have said about the importance of early intervention. In our service we work with over 18s, but I am aware with my clients that there are a number of children under 18 for whom there are no specific services. I know there are great parenting programmes out there, but I mean addiction and trauma informed. In my area in counties Monaghan and Cavan there is MaCYSS, which works with kids from 11 up. A lot of children under that age bracket are being affected by addiction in the home, however, and there are little or no services available for those children. I wanted to highlight that as something that needs to be looked at and taken into account.
Ms Annmarie Dunphy:
There is a lack of services outside of Dublin and in the country. There is a youth club in my town and the kids have to be in trouble to get access to that youth club. That should not be the way. It should be for every child. A lot of that brings peer pressure too. For women and men down the country there are no services. You have to travel to Dublin or the city. There are also the wait times. Tusla is coming in saying it is going to take the kids, and you have only so long to get into treatment. There are wait times to get into treatment. You have to have clean urine to get into treatment. There is a process that goes with that, and you are not given that chance. That needs to be looked at as well, for mothers in addiction to be given that chance to go through that process and come up with a solution.
Mr. Andy O'Hara:
We need to commit and there needs to be a mandate to build the infrastructure. If you want to listen to people, it takes an infrastructure. It takes a structured approach. There are quotes here from participants about why they do not make complaints or why they do not have a voice. They say things like none, no impact, nothing happens, still homeless, still in the same situation, none because they do not follow up on them. They say things like "I feel like I am living late today, and I want to give up." There is more drug use and more mental health, more trauma from being let down. One of them said that their mental health is not good, and they are just sent from pillar to post. They have lost hope for themselves and their kids. They are young and see no future. They are trying to get a care plan for six months as they need one to see the counsellor.
It is important we have a framework to listen to those people so they can tell us where the gaps are so we can create the solutions. There is another quote from our annual report, which is based around all the clear work that is happening. This person says that they think it is very important to give people who would never have a chance, a chance at getting their life back. When you are a person who uses drugs, or want to come off drugs, or are off drugs and are about 40, there is nothing out there for them. They say they want to give back and it is their aim to give back because they took so much from the town. Society has to be aware that people who use drugs are often not living their lives. They are surviving. Every day they are fighting to survive. With places like Uisce a lot more people would speak out about where the barriers are in the system and services. They would know what is out there for people and they could be pointed in the right direction.
It is about what happens when we do not listen to people, and when we do listen to people. It is about having that framework.
Ms Suzanne Tackaberry:
As a mother with two small children, I went into Ashleigh House residential and was given all of the supports. I have been given a key worker, but my children have also been given a key worker and supports in the crèche on-site in Ashleigh House. When we came out for the transition period, I still had my aftercare. I still had my support groups and fellowship. All of those supports were there for me. However, the supports for my two children stopped. There was no play therapist. There was no further key worker for the children. They were transitioning out of the treatment centre also at a young age. My five-year-old has behavioural issues at the moment and we are still trying to get her linked in with play therapists for some kind of support for her emotional regulation. I hear words that addiction does not affect only the individual. Everything that the person with addiction is feeling in terms of shame, guilt and remorse is being felt by the family member too. The dishonesty, hiding and not telling that the bills have not been paid. There is the shame of having a child or a sister as an addict, and what that impact is on the family. That goes for the children also. They are feeling that too. They are unheard and unseen. They are not given a voice. I come from two alcoholic parents as well. I did not have a voice at a young age. The family was torn apart. There was no one stepping in to help us. I am intergenerational. I have a sister who is not an addict and who has never suffered, but I did. If only someone had stepped in to our family. People knew, neighbours knew and schools knew. If there were supports for me at that time, maybe I would have had a chance.
In order to support my children now, they need the support. They are being impacted hugely. That needs to happen now to stop that intergenerational effect.
Ms Anita Harris:
I absolutely highlight what Ms Tackaberry talked about in the context of early intervention. There are many services around the country for people with substance misuse. What we have heard today is that families and children need to be treated in their own right. Recovery needs to be seen through the lens of families and children. Unless we have strategies within the national drugs strategy that recognise them in their own right, they will become an add-on. The family and children element will become an end-of-year add-on and given to organisations that can provide those services really quickly without any good strategy.
When we talk about early intervention and hidden harm, many of our children are not hidden at all. They are not hidden, as Ms Tackaberry talked about. The schools, neighbours and everybody on God’s earth know who they are. If the only option given to us is to be at fault for taking their child off them, all that does is put people under shrouds of secrecy and silence and to cause people to operate in pain. People need it to be their own strategy, where they become their own pillar in a strategy to look at the needs and supports of families, other family members and children, as well as what actually is in place. If an initial scoping exercise was carried out, there would be absolute shock because there are counties in the country that have no family support services and zero services for children. In the case of some counties, those services might just be in a part of the city but there is actually nothing in place elsewhere. That is where we could start in order to see where the needs are.
The national drugs strategy needs to be national. Unfortunately, sometimes the mouth that shouts the loudest gets the most, and that is applicable to areas, personalities and relationships. If we are ever going to be able to do anything about the national drugs strategy, it should not depend on relationships; it needs to be national and concern the national needs of the country.
Mr. Michael Mason:
Unfortunately, within services, you are nearly pitted one against the other for funding. That makes interagency work extremely difficult at times. Looking at a national level, FASN, a peer-led organisation, has worked alongside the RISE Foundation. We have seen how interagency work can be beneficial to everyone. It is about looking at the work that can be done between agencies and having someone to oversee that to look at best practice. Even in the context of peer support, it is beneficial. We talked about peer evaluation of delivery and best practice. This is what is needed in order that everyone throughout the country receives the same service.
Ms Aileen Malone:
It is very difficult to follow the speakers before me. All I can do is echo and completely agree with them. If we are serious about tackling problematic drug use, we must look at all the people around the person in addiction and help and support them. If we take a long-term view, we must tackle intergenerational drug use, prioritise children and put the proper supports in place. In the context of the whole chaos around crèche places at the moment, we must put proper supports in place for children. We also must take account of neurodiversity as well as trauma and put a lot of resources into those areas.
Frances Black (Independent)
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First, I am sorry I cannot be present at the committee meeting in person today. My signal was not great today so I was only picking up on some of the conversation. It has been a privilege to be presenting here today with such phenomenal organisations which do brilliant work. It is absolutely vital there is appropriate funding and policy support for all of these organisations that are doing great work. It is about connecting the dots, doing that interagency work and all of us working together because we all have the same aim. We are all working for the same thing. It is just about getting that awareness out there around the impact on the family. The recognition of the importance of family support is vital as part of a comprehensive public health approach in Ireland. Doing this work will reduce the long-term human and societal costs in general going forward. Through us all working together, we can break the impact and legacy of addiction. It will strengthen the fabric of families across all communities.
We need that national body. We need a body like FARI that could represent and be the umbrella group and voice for families that are impacted by problematic alcohol or drug misuse. That is really important. I pay credit to all the amazing work that is happening here today. It really is a privilege to have been here alongside all the witnesses. I thank the Cathaoirleach and the committee for their time. Go raibh míle maith agaibh.
Gary Gannon (Dublin Central, Social Democrats)
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From my part, it genuinely has been a privilege to hear the extent of the work the witnesses do, the heart they bring to it and the difficulties they have to overcome in order to deliver the services that are just based on kindness, decency and humanity. It should not have to be so hard. I thank the witnesses.
On the part of the committee, we have all been better informed from their presence here today. I hope, when we have our final document at the end, it captures exactly the reason the witnesses came in here. We will then have a template for what will be a better Ireland in terms of how we treat and care for people in issues of addiction. I thank the witnesses again and members of the committee. The meeting is adjourned.