Plain talking on the alcohol epidemic

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With the nation ’s love affair with alcohol as intoxicating as ever, Dr Garrett FitzGerald praises the work of the Aiséirí Treatment Centre in Wexford, which is quietly celebrating its 25th anniversary this year.

From the Irish Medical Times

The 25th Anniversary of the foundation of Aiséirí Treatment Centre in Wexford is being celebrated quietly and without alcohol in many homes throughout Ireland, perhaps between 4,000 and 6,000 in total. The families in these homes have good reason. Without Aiséirí ’s intervention in their lives, all would have been lost.

The Aiséirí group, founded in 1983 by Sister Eileen Fahy at Cahir, Co Tipperary  — where its first centre is located  — treats dependent and family members in a holistic/humane approach. Responding to need, the second Aiséirí facility opened in Wexford in 1987 and, more recently, a further centre in Ballyragget, Co Kilkenny (Aisling), directed specifically at the addiction-treatment needs of young people.

 ‘The Irish Thing ’ was the name given by non-Irish immigrants in early 20th-century New York to our unique fondness for strong drink. We are still depicted in the international media as a jollying, half-cut race who are the happiest bunch of losers on the sporting planet. It has been suggested that there would be very few supporters of the Irish soccer team present were the World/European finals held in a  ‘dry ’ country. It could be also argued that the nation might: a) prosper or, b) sink beyond trace if there was no booze available here for a year.

Public disorder

Where else would 15-year-old children regularly cause public disorder in celebration of the meaningless Junior Certificate examination results? What other nations would show-off their cultural zenith by making the highlight of a visit of the Queen of England or the President of the US none other than the placing before them of a pint of porter? Where else would you find a history extolling the likes of Father Matthew, who swore 1,000,000 people off the gargle?

The nation ’s love affair with alcohol is as ardent as ever, even as more and more public houses close their doors. At-home drinking of unmeasured aliquots of cheap supermarket booze has replaced the traditional pastime of going to the local. It ’s cheaper than ever to get wasted. A passable bottle of wine can be had for  €6;  €1 per unit of alcohol. Slabs of beer and cider can be had for even less unit cost.

Most citizens use alcohol moderately and probably have a net personal and social gain from its use. But such is the high regard for booze in the population that the average consumption is extremely high by international standards and the toleration of drunkenness unique.

Naturally, with such a backdrop, there will be many casualties along the way. Not all individuals are similar in their response to the ethanol molecule and 5-to-15 per cent of a population will become to some degree dependent.

There are several divisions of alcohol use disorders (AUD), from at-risk or high-risk drinking through functional alcohol dependence, to the most malign  — the state of severe, recurrent alcohol dependency.

I recall a noted boozer explaining it all:  “Doc, ” he said,  “I might go to the pub with my brother and have two drinks with him. His sense of well-being and his outlook on the state of the world would maybe improve by 10 per cent. Mine would go up 500 per cent. Then he ’d say he ’s had enough, he might get sick if he took any more. I can ’t understand why he bothers with it at all. I ’d be there hoping he ’d shag off soon so ’s I could get down to the business of keeping myself 500 per cent better. ”

Careers, wives, children, achievements, physical and mental well-being, reasonable responsibility and relationships cannot compete with a molecule which regularly enhances its victims ’ joie-de-vivre by 500 per cent  — no contest. In time, one by one, these will all be jettisoned in the delusional state of severe recurrent alcohol dependence, which rots the fabric of the dependent and family.

The Minnesota Model of addiction treatment, begun in the 1950s, has been and is being regularly adapted to recent understanding of the natural history and response to treatments. It is best suited to the more severe forms of alcohol dependency.

Typically, a 28-day in-house programme, followed by two years of outpatient aftercare and ongoing community-based support (Alcoholics Anonymous) strives to establish life-long abstinence and restoration of mental, physical, spiritual and social integrity in the dependent  — and family.

The  ‘family ’ aspect

The  ‘family ’ aspect has received a very small share of the attention in research into AUD. In this regard, Aiséirí also runs a  ‘halfway house ’ in Waterford for post-treatment addicts and a five-day residential course monthly in Cahir for severely affected family members.

Aiséirí is a charitable organisation, its foundation partly stimulated by the medication-fuelled approach of the times. It seemed to many that AUD was regarded in the then-medical model as a clinical state caused by a deficiency of Valium.

Today,  ‘tough love ’ is the order of the day. Aiséirí ’s good work continues. Long may it prosper for our patients ’ sakes.