Wednesday, 6 February 2008
National Waste Strategy: Statements
Pat Gallagher (Minister of State, Department of Health and Children; Donegal South West, Fianna Fail)
I pay tribute to the parties who agreed to this cross-party motion. That there is a cross-party motion is a statement of how serious is the problem of alcohol misuse and illegal drug use. I thank the Members who contributed to this important debate. As the Minister of State with responsibility for health promotion I will focus on alcohol. The Minister of State with responsibility for drugs, Deputy Pat Carey, contributed to this debate last week.
The motion raises issues of serious concern for our society. The problems associated with alcohol misuse and illegal drug use are extremely serious but I am somewhat reluctant to describe the situation as an epidemic. However, I fully appreciate the gravity of the situation facing us in Ireland today.
Let me begin by speaking on the problem of alcohol misuse. Alcohol harm is visible in every town and village, on the streets, in the courts, in the hospitals, in the workplace, in the schools and in the homes. Despite the tendency to blame under age drinkers, the vast majority of alcohol harm occurs among the adult population. It manifests itself for example in street violence, accidents, hospital admissions, drunk driving, alcohol poisoning, suicides, alcohol dependency and cancers. Some of these problems, especially the acute problems, arise where the light or moderate drinker drinks to excess on a single drinking occasion, while others result from regular heavy drinking over a longer period of time.
Our drinking patterns give cause for concern. In a study published by the European Commission in March 2007, Ireland was reported to have the highest percentage of binge drinkers of 25 European countries. This drinking pattern is adding to the burden of ill health and self-harm. Ireland is ranked as the highest among the 35 European countries in terms of the adolescents who regularly binge drink and second highest in reported regular drunkenness. The health behaviours of school aged children study, which I launched last year, shows that half of the children aged from 15 to 17 reported that they are current drinkers and more than one third reported they had been really drunk in the previous 30 days.
Alcohol consumption in the Irish population has increased by 17% in the past 11 years. This has had an impact on health whereby alcohol-related hospital admissions increased by 92% between 1995 and 2004. Alcohol related liver diseases increased by 147% between those years. In order to gain some perspective of the relationship between alcohol misuse and ill health, it is worth noting the findings of the World Health Organisation global burden of disease study, which shows that alcohol was the third most detrimental risk factor for European ill health and premature death, which was only surpassed by raised blood pressure and smoking. Alcohol was slightly more important than high cholesterol and being overweight, two and a half times more important than physical inactivity, and four times more important than illicit drugs. I have no doubt that the European risk factors have greater relevance in Ireland than they have in many other European countries. All this research evidence and information just confirms to us what is all too late and all too visible in our society. Such research should serve to strengthen our resolve to tackle alcohol problems and to seek meaningful ways to address the problem.
The motion before us is an expression of the strong desire among public representatives across all parties to do something about this problem. We all have a part to play. We need to take responsibility both collectively and individually. We need to examine our social acceptance of alcohol and the signal it is sending, particularly to our young people. Alcohol has become too closely associated with many celebratory events and in people's lives. We must ask ourselves if adults provide an appropriate, example to younger people regarding alcohol. It needs to become socially unacceptable for people to be excessively drunk our streets. This change can only occur when we stop excusing such behaviour. How many times can we remember smiling benignly at the friend, relative or family member who has had too much to drink and behaves inappropriately?
There is a developing scientific knowledge of what strategies work to reduce alcohol related harm. The World Health Organisation has stated that policies and programmes based on substantive evidence should use an appropriate combination of the following strategies: regulating the marketing of alcoholic beverages, in particular those practices that influence younger people; regulating and restricting availability of alcoholic beverages; enactment of appropriate drink-driving policies; reducing the demand for alcohol through taxation and pricing mechanisms; providing easily accessible and affordable treatment services for people with alcohol-use disorders; and implementing screening programmes and brief interventions against hazardous and harmful use of alcohol, for example in primary care and accident and emergency departments.
Implementation of many of these policy measures requires cross-departmental support. That is why a cross-departmental approach holds out the best opportunity of achieving progress. I am conscious of the need for the Government to continue to respond to the problems caused by alcohol misuse and it is my intention to continue to seek support for the introduction of evidence-based measures to tackle these problems in our society.
The motion before us acknowledges the need for a co-ordinated cross-departmental approach to the problems of alcohol misuse and illegal drug misuse. This type of cross-departmental and cross-sectoral approach is already taking place regarding alcohol misuse. In July 2005, a working group on alcohol was established to help mobilise the stakeholders through social partnership to achieve a targeted and measurable reduction in alcohol misuse. The working group operated in the context of the special initiative on alcohol and drug misuse under sustaining progress. The group comprised the social partners, relevant Departments, the Garda, the national drugs strategy team and the Health Service Executive. It examined the issues of under age drinking, drink driving and high-risk drinking. The report, published in June 2006, recommended a set of actions on issues such as community mobilisation, workplace alcohol policies, labelling, and education and awareness. An implementation group was established in November 2006 to monitor and report on progress on the implementation of the recommendations. The implementation group is expected to report early this year. It is generally agreed that the Sustaining Progress initiative has allowed a broad range of stakeholders to work together towards the common goal of reducing the harm caused by alcohol misuse
Arising from concerns about the effect that alcohol consumption is having on public order, the Minister for Justice, Equality and Law Reform established an alcohol advisory group to advise him on the measures that might be taken to address concerns regarding the sale and promotion of alcohol products. This matter was raised by a number of Senators. The alcohol advisory group is expected to report to the Minister by 31 March. An official from the Department of Health and Children and an official from the Department of Justice, Equality and Law Reform are members of the advisory group.
Regarding cocaine, I would hesitate to use the term "epidemic".I acknowledge there has been an increase in the use of cocaine in recent years. Less than two weeks ago my colleague, the Minister of State, Deputy Pat Carey, launched the results of the drugs prevalence survey for 2006-07. This is a follow-up to the survey carried out in Ireland and Northern Ireland in 2002-03 and it covered the 15 to 64 age group. The survey shows that cocaine use has grown, albeit from a low base, particularly among the young adult population. A total of 5% of respondents reported having used cocaine in their lifetime. A total of 1.7% reported using it in the previous year and less than 1%, 0.5%, reported using it in the previous month. In the younger age group of 15 to 34, these figures rose to 8.2% for having used, 3.1% for use in last year and 1% for use in the previous month.
The increase in cocaine use is in line with the findings of the national advisory committee on drugs and the national drug strategy team report, completed in 2006. It concluded that, based on all secondary indicators including numbers coming forward for treatment, there was a significant increase in cocaine use, albeit from a low base.
There are existing synergies in the area of treatment for substance misuse and a potential for strengthening these. Historically the drug treatment services in Ireland, in particular in the greater Dublin area, developed primarily to deal with an opiate-using client group. However, drug use patterns have been changing, in particular towards poly-drug use, which includes alcohol, illicit drugs and legal drugs. The consequent changes in the problems which people bring to the treatment services mean that a more holistic approach is called for, based on the needs of the individual client. The national drug treatment reporting system maintained by the Health Research Board reports that one in five people receiving treatment for alcohol use in 2004 and 2005 reported problem use of at least one other drug, with more than 10% and 5% reporting problem use of two and three additional drugs, respectively. Of particular concern is the increase of 45% between 2004 and 2005 in the number receiving treatment for both cocaine and alcohol use. When cocaine is taken with alcohol it combines in the system to form the drug coca-ethylene which is more toxic than using either substance alone.
To address these changing patterns of drug use, the HSE has been re-orientating its services towards a more integrated approach to both alcohol and drugs. It is working to include its addiction services in the primary care teams and social care networks which are currently being rolled out. It is considered that this setting offers the best opportunity for providing a continuum of care to clients, including people with substance misuse problems and meeting clients' needs in a holistic way.
The 2006 joint report on cocaine by the national advisory committee on drugs and the national drugs strategy team, 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 as being suitable for substance use in general. The HSE has identified that many approaches already in use work well with cocaine misusers and it intends to build on this approach and re-engineer existing services to meet emerging needs such as cocaine misuse.
I refer to the combined alcohol and drugs policy. The suggestion of a single national substance misuse strategy has been mooted. However, for many reasons it is believed it is best to treat the addictions separately. For example, with respect to education and awareness, the messages communicated about alcohol are not necessarily appropriate to illegal drugs. A zero tolerance approach is generally warranted for illegal drugs whereas with regard to alcohol it is preferable to alert people to alcohol misuse.
The mid-term review of the National Drugs Strategy 2001-2008, contained the recommendation that a working group should be established to explore the potential for better co-ordination between alcohol and drug policies, and whether a combined strategy is the appropriate way forward.
A number of meetings of this working group, which is chaired by the Department of Health and Children, have taken place. The working group is cross-departmental and cross-sectoral. Membership comprises the Department of Community, Rural and Gaeltacht Affairs, the Department of Justice, Equality and Law Reform, the Department of Education and Science, the national drug strategy team, the Health Service Executive and the social partners, in addition to the Department of Health and Children. The membership reflects recognition of the need for a co-ordinated cross-departmental approach to the working group's terms of reference. Work is ongoing in identifying areas of synergy and in considering whether a combined strategy is the appropriate way forward. I await with interest the conclusions of the working group on how we might move forward in this difficult area.
I do not underestimate the challenges ahead when dealing with alcohol and drugs. Addressing these challenges through cross-departmental and cross-sectoral working groups is the best opportunity for making progress. The benefits of cross-departmental working have yielded dividends in the past and I have no doubt they will do so in the future.