Frances Black (Independent)
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I would like to thank the Minister for coming to the House this morning to deal with this Commencement matter and to congratulate her on her appointment. Alcohol misuse in Ireland is an issue about which I am passionate. For the benefit of the Minister, I will repeat the data I read into the record during yesterday's Order of Business, as set out in the Health Research Board's national alcohol survey. More than 150,000 Irish people are dependent drinkers; more than 1.35 million people are harmful drinkers, and 30% of people interviewed said they had experienced some form of harm as a result of their drinking. The survey also reveals that 75% of alcohol consumed in Ireland is consumed while binge drinking and that we underestimate what we drink by about 60%. There is a massive unmet need in this area. Alcohol-dependent individuals need psychosocial intervention and therapy, and hazardous drinkers need brief interventions to minimise the chances of their progressing to dependency. It is important to make that point.

I would like to provide some more facts and figures from the survey, because they are quite shocking. Some 88 deaths every month in Ireland, or three per day, are directly attributable to alcohol, which is frightening. There are almost twice as many alcohol-related deaths as there are deaths as a result of all other drugs combined. Nine hundred people in Ireland are diagnosed with alcohol-related cancers and around 500 people die from these diseases every year. Alcohol is a factor in half of all suicides in Ireland. We know we have a huge problem with suicide, but the fact that alcohol is involved in half of all suicides is horrendous. Alcohol is also involved in over one third of cases of deliberate self-harm, peaking around weekends and public holidays. More than 14,000 people were admitted to the liver unit at St. Vincent’s Hospital for treatment due to alcohol dependence in 2011. Every day, 1,500 beds in our hospitals are occupied by people with alcohol-related problems. Alcohol-related illness cost the health care system €800 million in 2013.

These are a few of the stark figures from the Health Research Board’s survey on alcohol harm. Behind those figures are thousands of family members who require support and guidance in dealing with the stress, anxiety and heartbreak of a having a loved one with an alcohol problem. For a concerned family member or a person identified as having an alcohol misuse problem, accessing services is difficult, which is my concern. The first port of call for people who are anxious that their loved one might have an alcohol problem, or who themselves might have an alcohol problem, is the Internet. The website provided by the HSE, www.drugs.ie, is amazing. I commend all the people involved in its operation. I did a search of that website, specifically looking for supports that specialise in alcohol dependency, and found that the only services available in counties Donegal, Galway, Wicklow, Limerick, Cork and Wexford were Alcoholics Anonymous and Alateen, which we all know are peer-to-peer support groups. Based on the startling and worrying facts linked to alcohol misuse, this is a very worrying indication of the lack of support we are offering our citizens. In not offering early interventions, we are prolonging the agony for the people involved and their families and we are allowing the problem to escalate over time, increasing the heartache for all concerned, as well as giving the HSE a much larger and more difficult problem to deal with in the future.

A report commissioned in 2007 by the HSE, chaired by Professor Des Corrigan from Trinity College Dublin, found that there is severe under-provision of residential places. The report also recommended that mixed treatment for alcohol and other substances should be considered more or less on a county-by-county basis, with input from service providers. We know the benefits of alcohol-only services over mixed-substance services in some settings. I suggest that a minimum number of treatment places be set aside for alcohol services and that the ratio of alcohol-only services to mixed-substance services should be discussed by all involved in treatment. Funding should be earmarked for these services.The national drug strategy is being rewritten and is due for completion by the end of the year. My concern is that if alcohol is not included, it will be forgotten. Funding for that needs to be included in the Estimates that are being put together in advance of the budget in October. As the Minister of State knows better than I, a great deal of alcohol-related harm is hidden and does not reach the public realm. I refer to self-harm, gender-based abuse, physical abuse, sickness, absence from work and economic desolation. The published harms represent a minimum level; the levels relating to real harms are higher. Will the Minister of State provide an overview on what support the State offers to those who have problems with alcohol and, in particular, their families?

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank the Senator for raising this matter and I acknowledge her good wishes to me in my new role.

I wish to reassure the Senator that the Government is committed to tackling alcohol misuse and is cognisant of the widespread harm and pain it causes. Alcohol is causing significant problems across the population - in workplaces and to children - and is a substantial burden to all in society. The HSE provides services to prevent and treat addiction to alcohol. People who present for alcohol addiction treatment are offered a range of interventions, namely, initial assessment, comprehensive assessment, the Minnesota programme, brief intervention, individual counselling, self-help, peer support or a combination of these depending on the individual. The delivery of these services is based on the four-tier model of treatment intervention and services are designed to respond to the individual’s specific identified needs. This care model implies that clients should be offered the least intensive intervention appropriate to their need when they present for treatment initially.

Interventions range from community and family-based supports through to primary care services and specialist support services either in the community or residential settings. Inter-agency working involving the HSE, drug task forces and multiple other community, statutory and voluntary agencies forms the basis of this delivery, as the target is to provide services, where possible, in a community environment. Counselling and rehabilitation services provide care to those presenting with an addiction through one-to-one counselling and onward referral to other statutory and voluntary groups where appropriate. The HSE also provides funding to a number of voluntary service providers who treat drug and alcohol addictions. The remit of the drugs task forces was extended to include the problem of alcohol misuse in 2014, in view of the central role they play in coordinating the response to substance misuse at local level. Last year, five drug and alcohol task force areas developed implementation plans to reduce alcohol-related harms, with a further five task forces developing implementation plans in 2016. The Senator will acknowledge that this is something in which she is interested.

The experience of children living with and affected by parental substance misuse has become widely known as "hidden harm". These children are often not known to services and suffer harm as a result of their parents substance misuse. The importance of recognising hidden harm and ensuring these children are identified and supported at an earlier stage cannot be underestimated. The HSE's addiction services and Tusla have collaborated on the development of a hidden harm strategy statement. The statement, which is due to be published shortly, will address what needs to happen to create the structures, processes and continuum of care to effectively respond to hidden harm. In addition to providing services to those impacted by alcohol abuse, the Government is working to reduce alcohol consumption and to address the underlying causes of alcohol misuse, that is, affordability. availability and attractiveness. The Government approved the publication of the Public Health (Alcohol) Bill 2015 and its introduction in the Houses of the Oireachtas last December. The Bill completed Second Stage in the Seanad on 17 December and I expect that it will commence Committee Stage early in the next term. I am anxious that it be prioritised to resume its passage in the next term.

Frances Black (Independent)
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I thank the Minister of State. I welcome the fact that the Public Health (Alcohol) Bill 2015 will go through the Houses. That is fantastic and it will keep the conversation going. I also welcome the hidden harm report. Implementation is vital, particularly for children who live in homes. Nobody understands the impact of hidden harm. I work with families who have loved ones with alcohol and gambling problems. The main issue is alcohol and it causes devastation within the family. When people want to step into recovery, they find it difficult to access a service. When a family approaches the RISE Foundation and asks where their loved one can go, they find it difficult to access services, particularly if they are in counties Galway or Donegal. People in many counties do not know where to get support. We refer them to the website, www.drugs.ie, but it is still difficult to access a service that deals solely with alcohol abuse.

We have a significantly unhealthy relationship with alcohol in Ireland. Three people a day die from an alcohol-related issue. It is important that alcohol addiction be tackled separately from everything else. Sometimes it is included with the drugs issue or mental health issues and while there is no doubt dual diagnosis needs to be addressed, the alcohol issue needs to be examined first. Services are vital and more residential services are required. I look forward to working with the Minister of State on this issue. We can work well together on it but I will not let go of it. That is why I am in the House and it is important that we make changes in this area. I hope we can concentrate more on services in this great country of ours.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I very much look forward to working with the Senator on this because her expertise in this area is acknowledged. I am concerned about the point she raised regarding the lack of services in some counties. I will follow up on that to ascertain what can be done to fill the gaps she has identified. Every county is affected by this issue. If there are services in one county, there should be services in another county to match them.

As a society, we have to address our relationship with alcohol. Even 20 years ago, none of us would not have recognised alcohol as a drug and it is timely to have that debate now. It is also time for us to hold up a mirror to society and discuss what we are doing to ourselves, our children and our health services. Consuming alcohol in the home makes it become like consuming any other product. It is a specific, separate product and if children are exposed to that, it will become the norm for them. If people are doing their grocery shopping and a child is sitting in the trolley, they will reach for milk on one self and alcohol on another. This is the path for the child to view the consumption of alcohol as the norm. This is a challenge for everyone in society. The Public Health (Alcohol) Bill 2015 will seek to address this. I look forward to working with the Senator on this issue and on the passage of the Bill through Committee Stage.