Pat Carey (Dublin North West, Fianna Fail)

I wish to thank Members of the Seanad for the opportunity to discuss this important issue which has been in the public domain at a very high level for some weeks. We are discussing the need for a co-ordinated cross-departmental approach to the problem of alcohol misuse and illegal drug use, in particular cocaine and related substances. I commend the House for linking the two issues. I will try to argue why I believe there is potential for more synergies between both.

With respect to the use of the term epidemic, it is important to maintain perspective around this in the context of cocaine. I accept we have a growing problem with respect to cocaine use and, equally, while I accept it is across all strata of society, it is primarily an urban phenomenon and is predominantly a problem with young or younger adults in the 15-34 age group. The last prevalence study in 2002-03 indicated that while 3% of respondents aged 15 to 64 reported that they had taken some form of cocaine at some stage in their lives, 1.1% used it in the last year and 0.3% used it in the last month. Results of the 2006-07 prevalence survey, which will be launched at the end of January, will reflect the findings of the joint national advisory committee on drugs and national drug strategy team report, completed in 2006. It concluded that based on all secondary indicators, there was a significant increase in cocaine use albeit from a low base.

With respect to alcohol, in contrast, prevalence figures in the 2002-03 survey showed that more than 75% had a drink in the last month and in 2006 the average consumption per person in Ireland aged 15 years or over was 13.36 litres of alcohol, which is a decrease from the peak of 14.3 litres in 2001. There are signs that its misuse is creating significant health problems for individuals and is contributing to public order offences in our towns and cities. With respect to alcohol use, key concerns relate to under-age drinking, binge drinking among young adults leading to potential public order problems and the levels of excessive drinking that can give rise to significant health problems for the individuals involved.

The Department of Health and Children, which has responsibility for alcohol, published the two reports of the strategic task force on alcohol that together provided approximately 100 recommendations across a wide range of sectors and involved policies, such as regulating and restricting alcohol availability; reducing the demand for alcohol through taxation and pricing mechanisms; regulating the marketing of alcoholic beverages, in particular those practices that influence younger people — in other words promotions; implementing appropriate drink-driving policies; implementing screening programmes and brief interventions against hazardous and harmful use of alcohol; and providing easily accessible and affordable treatment services for people with alcohol use disorders. While the first three are not an option with respect to illegal drugs, there are potential synergies that may be achieved with the remainder.

In the last Dáil, the Oireachtas Joint Committee on Arts, Sport, Tourism, Community, Rural and Gaeltacht Affairs, in its ninth report in 2006, reached the conclusion that alcohol should be included in a new national substance misuse strategy and that there should be a co-ordinated response along the lines of the national drug strategy. My predecessor indicated, when he appeared before the committee, that he had an open mind on the issue and was supportive of bringing together any potential synergies that can be identified. From the time of my appointment as Minister of State I have indicated that I support this view.

The committee was aware, as Senators will be aware, that this suggestion of a single national substance misuse strategy has been mooted for a considerable time. The Department of Health and Children, which has overall responsibility for the co-ordination of alcohol policy, is currently investigating this issue and established a working group in December 2006 to examine the issues and the potential synergies involved. This group, which in part arises from action 80 of the national drugs strategy, consists of representatives of the Department of Health and Children, the HSE, the Department of Justice, Equality and Law Reform, the national drugs strategy team, my own Department and representatives from the community and voluntary sectors and the industry. It is expected to report early in the new year.

The steering group appointed to oversee the mid-term review of the national drug strategy, which was completed in 2005, was struck by the number of times the issue of alcohol, particularly binge and teenage drinking, was brought up during the consultation process and the confusion that was felt by some that there were separate strategies to deal with the issue of illegal drugs and drinking. A number of contributors to the process felt, as the Oireachtas committee concluded, that alcohol and illicit drugs could be addressed through one overall policy.

While the steering group dealing with the mid-term review of the national drugs strategy considered that the question of a combined alcohol and drugs strategy was beyond its remit, it pointed out that although separate policies are involved, in many cases services addressing issues of substance misuse on the ground are not separate. With respect to the key areas of prevention, treatment, rehabilitation and supply reduction, the steering group was of the view that there was potential for synergies between the two strategies, but that there were also areas of divergence.

For example, with respect to education, most educational activities focused on prevention adopt a skills-based approach and cover substance misuse in general, rather than any specific substance, or group of substances. However, in public awareness campaigns, messages need to be credible and effective and the steering group was of the opinion, with which I agree, that addressing alcohol and illicit drugs together can be problematic, given that the messages communicated on alcohol are not necessarily appropriate to illegal drugs. Generally, a zero tolerance approach is warranted for illegal drugs whereas with respect to alcohol it is more about alerting people to the dangers involved and getting across the message of people developing a responsible attitude to drinking.

The health promotion unit of the HSE has responsibility for developing public awareness campaigns about both alcohol and illegal drugs. Evidence identified by the national advisory committee on drugs suggests that maximising the impact of national campaigns is best realised by having co-ordinated local campaigns in tandem with national campaigns. There is therefore significant scope for greater co-ordination in raising awareness in society about the dangers of illegal drug use and problem alcohol use.

The greatest opportunity for synergies may lie in the area of treatment for substance misuse. Clients have different needs and the Government is seeking to put drug related treatment in place that is client centred, thus addressing all the issues personal to the individual problem drug user, including alcohol-related treatment where necessary. Many of the people now presenting exhibit problems related to polydrug use, including alcohol, and it makes sense to adopt an holistic approach. This more holistic and integrated approach is reflected by the work of the HSE's working group on residential rehabilitation on substance use which reported in the summer to the HSE. The HSE's working group on drugs and alcohol is currently considering the report. The residential rehabilitation working group, on which my Department was represented, considered the residential rehabilitation needs of misusers of all substances, including alcohol.

With respect to cocaine, the joint report by the national advisory committee on drugs and the national drugs strategy team, to which I alluded earlier, while recommending, in the short term, the need to consider the provision of cocaine-specific clinics recommended that in the medium to longer term there is a need to move to the provision of a comprehensive substance treatment service tailored to the individual. This is recognised by the HSE and in its report last week to the interdepartmental groups on drugs, of which I am chairman, identified that many approaches already in use work well with cocaine misusers and that it intends to build on this approach and re-engineer existing services to meet emerging needs such as cocaine. Further evidence of this enhanced co-ordinated approach by the HSE is the associated training programme, which is currently being rolled out. This training is available not only to HSE staff but also to workers from the community and voluntary sectors and will cover a number of themes including drug and alcohol misuse in both acute care settings and non-specialist settings and evidence-based practice with substance misuse.

In the context of supply reduction, the legal status of alcohol, as against that of illicit drugs makes closer linkages between policies difficult to achieve. However, under-age drinking is, of course, illegal and I strongly agree that the laws relating to the sale and supply of alcohol to those under age should be rigorously enforced and that concerns expressed about easier availability need to be considered, particularly in the context of under-age drinking.

In the context of a combined national substance misuse strategy, historically, drugs task forces have tended to have varying views, with regional drugs task forces tending to be more open to the idea. In the past, local drugs task forces generally would be more of the view that the policies should be kept separate. The LDTF view probably related to the nature of the illicit drugs problem and the need for a focused response. Some people are still of the view that robust structures are in place to deal with illicit drugs and that their effectiveness in that regard might be blunted by trying to address the much broader and pervasive alcohol issue in the same way. From my interactions with drugs task forces and from the work of the NDST in canvassing the views of task forces earlier this year, I perceive that while there are concerns about ensuring that services to existing clients are not diluted, there is greater willingness for and acceptance of a single strategy, particularly in view of increasing polydrug use and the role of alcohol in the take-up and continued use of illicit drugs.

At an international level there is no single approach to the issue, though the 2006 annual report of the European Monitoring Centre on Drugs and Drug Addiction reports, "signs of a broadening of the scope of strategies to encompass licit addictive substances (alcohol, tobacco, medicines) as well as illicit drugs". As chairperson of the British-Irish Council sectoral group on the misuse of drugs, I note that Ireland, England and Scotland have separate polices, with the other five jurisdictions adopting a combined approach. To an extent the policy approach may be driven by whether jurisdictions view their response to substance misuse as primarily a health issue or a legal issue. Irrespective of this, to the extent that there is scope for greater co-ordination of our responses to the problems involved, we should pursue it.

I agree with the overall thrust of the motion. The important thing is that any co-ordinated cross-departmental approach would retain and build upon the successful aspects of the national drugs strategy while simultaneously addressing the alcohol issue in a more co-ordinated and effective way. Meanwhile, I await the outcome of the deliberations of the working group led by the Department of Health and Children which should significantly facilitate decision-making on the appropriate way forward and should facilitate the development of the most appropriate co-ordinated approach to the twin concerns of illegal drug use and problematic alcohol use.

I look forward to this debate particularly as the steering group on the new national drugs strategy will be meeting just after Christmas. The terms of reference have been outlined to the group and it will engage in wide consultation, which in my view, starts here. It is appropriate that the elected Members of both Houses should be among the first to give their views. I look forward to this opportunity to engage with the Members and I welcome any proposals.

The Fine Gael leader, Deputy Kenny, indicated that the strength of the strategy to date has been the broad cross-party support and I hope this will continue. I am under no illusions about the challenges which face us but significant progress has been made in a wide range of areas. We have more and very important work to do.