Shane Butler

Cocaine Use in Europe – A Multi-Centre Study: Patterns of Use in Different Groups

Aim: The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities. Design, Setting, Participants: Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment. Measurements: Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine. Findings: The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days. Conclusions: The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account.

The Making of the Methadone Protocol: the Irish system?

Treatment service provision for problem drug users in the Republic of Ireland until the mid-1980s was centralized, specialist and ideologically tending towards abstinence models of intervention. However, in the context of continuing heroin use and its accompanying public health risks, all these features of policy and service provision changed gradually over the next decade. This paper looks in detail at the evolution of the methadone protocol of 1998, which institutionalized and regulated methadone prescribing by general medical practitioners in Ireland. It discusses the main stakeholders, lists the sequence of events and looks analytically at the policy process. It is concluded that the introduction of the methadone protocol was a pragmatic success, albeit one which departed significantly from conventional beliefs about policy transparency in democratic societies.

Obstacles to the implementation of an integrated national alcohol policy in Ireland: nannies, neo-liberals and joined-up government

This article explores how proponents of a public health model of alcohol policy have, for more than a quarter of a century, argued consistently but unsuccessfully for an integrated national alcohol policy in the Republic of Ireland. It looks in particular at the past decade, a time when increases in alcohol consumption and related problems strengthened the case for such an integrated policy, and when managerial innovations in the sphere of cross-cutting management appeared to provide a template for its implementation. A number of explanations are offered for the refusal of successive governments to respond to what its advocates see as the only rational, evidence-based approach to the prevention of alcohol problems. It is argued that, unlike the Nordic countries, the political culture of independent Ireland has never been one in which the state could unilaterally impose strict alcohol control policies as a feature of its broader vision of the welfare state. It is also argued that during the recent period of economic prosperity (the so-called ‘Celtic Tiger’ era) the country was characterised by a neo-liberal policy climate, which was specifically antipathetic to the idea that the state should interfere directly in the alcohol market with a view to preventing related problems. It is suggested that the social partnership model of governance, to which many people attributed the country’s economic success, created an atmosphere of consensualism within which the state as mediator between the two main protagonists (the public health lobby and the drinks industry) was unwilling to challenge the drinks industry. It is also concluded that this failure to create a national alcohol policy based on public health principles demonstrates the limitations of the cross-cutting, or ‘joined-up’, approach to public management in those areas of social policy characterised by clashing value systems or fundamental conflicts of economic interest. Finally, it is acknowledged that in Ireland, as elsewhere, neo-liberal certitudes have been effectively dethroned by the economic recession and banking crisis of late 2008; whether these more straitened economic circumstances will provide a better fit for the ‘nanny state’ ideals of the public health perspective on alcohol remains to be seen.

The great Irish head shop controversy

This research describes and analyses recent policy developments in Ireland in relation to the practice of selling psychoactive substances which, while not themselves illegal, mimic the effects of commonly used illegal drugs. These so-called ‘legal highs’ had been sold in Ireland through an increasing number of ‘head shops’ which in late-2009 and early-2010 became the subject of considerable public controversy, culminating in legislative measures aimed at their closure. Based on semi-structured interviews with some of the main stakeholders in this process and set against a background of saturation media coverage of this phenomenon, this article presents and assesses competing perspectives on the head shop issue. From a conventional drug control perspective, recent legislative measures in Ireland may be seen as representing effective cross-cutting activity between the health and criminal justice sectors. From a harm reduction perspective, however, this policy response may be seen as an example of moral panic in that media portrayals greatly exaggerated the ill effects of head shop products, in the process stoking public anger rather than encouraging rational debate.

The globalization of addiction: A study in the poverty of spirit

Review essay. Bruce Alexander, Emeritus Professor of Psychology at Simon Fraser University in Vancouver, is probably best known for his â?~Rat Parkâ?T experiments (Alexander, Beyerstein, Hadaway, & Coambs, 1981): experiments which confirmed cleverly and imaginatively the inadequacy of research which purports to explain psychoactive drug use and dependence solely in pharmacological terms, while ignoring environmental factors. His latest book, The Globalisation of Addiction, may be seen as a synthesis of his lifelong study of this topic, reaffirming and summarizing his convictions about the limitations of biomedical models of addiction.

Ireland’s Public Health (Alcohol) Bill Policy Window or Political Sop?

In the wake of the Steering Group Report on a National Substance Misuse Strategy in 2012, the Irish government announced in October 2013 that it had approved a number of alcohol policy measures to be incorporated into a Public Health (Alcohol) Bill to be drafted and enacted as quickly as possible. Against a historic backdrop of previous alcohol policy proposals in Ireland in recent decades, this article looks critically at this recent development with a view to determining to what extent it represents, in Kingdon’s terms, a “policy window” for the public health approach to alcohol issues. It is argued that while some specific public health measures may be introduced, the various “streams” of the Irish policy process have not joined together in an unambiguous, consensual acceptance of the public perspective on alcohol, and that the “politics stream” has not to date deemed this perspective to be consonant with the “national mood.”

Addiction counsellors in the Republic of Ireland: Exploring the emergence of a new profession

This article reviews the emergence and expansion of addiction counselling as a specialist form of professional practice with problem drinkers and drug users in Ireland, over the past 30 years. It sees addiction counselling as having its roots in a widely shared disenchantment with the ‘medical model’ of addiction treatment, and identifies the main factors which have shaped the growth of this new profession over this period. It is argued that statutory health authorities have largely allowed addiction counselling to evolve in an ad hoc style: ceding maximum discretion to individual counsellors and teams of counsellors, while making minimal efforts to standardize counsellor training or to integrate the counsellors’ work into a broader, coherent health service response. Reference is made to attempts currently under way to establish statutory registration systems for addiction counsellors in this country, which, if successful, should raise standards of practice and provide greater protection for members of the public availing themselves of such services. It is also argued, however, that both statutory registration and implementation of Tiered Care models of service delivery are likely to reduce the level of autonomy which addiction counsellors have traditionally enjoyed vis-a-vis service managers.

Substance misuse and the social work ethos

The contribution which social work can make to the resolution or minimization of problems stemming from the use of alcohol and drugs is best understood in the context of the professions ethos. This ethos is one which, unlike that of most other caring professions, retains and encourages a sense of scepticism concerning the prospect of technical or scientific solutions to these problems, preferring to work explicitly within the sphere of policy and of value issues. Three major themes (the person-in-environment, the strengths perspective and the emphasis on service provision) are looked at in the context of Irish social work.

Irish Alcoholic Women in Treatment: Early Findings

Alcoholic women in Ireland, as in other countries, tend to drink alone and a minority are pub drinkers. There are scant data about alcoholic women who are treated as well as about the outcome of such treatment. A representative sample of women in treatment were interviewed based on consecutive admission to treatment centers in Ireland. The women will be interviewed again 1 year later. Drinking patterns, use of other drugs, parental drinking, and troubles associated with drinking are described.

Tipping the balance? An Irish perspective on Anderson and Baumberg

This brief comment on Anderson and Baumbergs () review of alcohol in Europe looks at this report from an Irish perspective, with a view to assessing its impact on the alcohol policy debate which has been a feature of Irish society over the past decade. It is argued that the reviews empirical data and their accompanying policy recommendations are already broadly familiar to Irish stakeholders in the alcohol policy process, but that the provenance of this report---which has been prepared for the European Commission—creates further potential to tip the balance of Irish alcohol policy in the public health direction espoused by its authors.