Michelle Culligan Thesis

Introduction and summary

Heroin is a major contributor to social problems in Ireland.  Addiction to this drug impairs personal, social and economic development by not only demoralising the individual using the drug, but by causing a ripple of devastation to their families, throughout communities and the wider society.  Research suggests that of all the illicit drugs widely used within Irish society, such as cannabis, ecstasy, amphetamines and cocaine, it is heroin that poses the highest risk to the individual and the general public (O’ Gorman, 1998, MQI, 2006, NCAD, 2005).  I would agree with this statement.  I would also propose that treatment for heroin addiction is the most controversial.  Addiction to other drugs, as mentioned, is generally treated by counselling or psychotherapy, whereas addiction to the opiate heroin is treated with another opiate methadone.  I became aware of this when my teenage daughter became addicted to heroin.  Heroin was alien territory to me so the news came as a great shock.  My initial response was to seek advice from a local addiction service.  Their response was to start methadone treatment to curb my daughter’s craving for heroin and eliminate the need for her to support her heroin habit.  After meeting with a specialised Doctor in Trinity Court on Pierce Street, treatment soon started.  I made it very clear this was to be a short term solution, and it was.  After three months of methadone treatment and successive sessions of counselling my daughter recovered from her heroin addiction.  In hindsight, I believe we were the lucky ones, in that the treatment was effective, but I feel this was because of my insistence of a short programme and my daughter’s determination to overcome her addiction.  The experience of having to go to a grubby, unwelcoming environment is not one I would wish on anyone.  However, it is through this experience and through dialogue with other service users that I became aware of the tribulations of methadone: ‘it gets into your bones’ one said, ‘it makes me sweat’, said another, the stories went on.  These stories inspired me to get involved with a group of local people who were setting up a local addiction service that would advise and support addicted individuals and their families.  It is my community work that exposed me to the full extent of the methadone problem.  Time and time again I’ve heard that when service users asked their Doctor for support to come off methadone, the answer is ‘no – you’re not ready’.  These people, who are left on methadone for years, are being treated like automatons.  It is as if the methadone programme is designed to work for every heroin addict with little regard for the person’s sense of agency, their autonomy or concern for the holistic well-fare of the addict.  

One key question that this thesis seeks to explore is why does methadone maintenance as a systematic medical intervention not work?  In other words, why does it not respond to all or some of the goals of overcoming addiction?  To try to answer this question I will take a multi disciplinary approach to investigating the varying factors that shaped methadone treatment in Ireland.   

In chapter I propose to give an overview of the drugs crisis in Ireland and elucidate the two main areas of concern in relation to heroin drug use: the social aspect and the harm to the individual using the drug.  Then I will trace the history of heroin in Ireland highlighting the key moments that changed Irish drugs culture and shaped Irish drugs policy.  In Chapter II will explain how methadone was considered a solution to heroin addiction.  Then I hope to highlight the pros and cons of methadone treatment in an attempt to see if it works, offering my personal views, the voice of service users and staff who work within the methadone clinics.  Then I will explore the model of treatment methadone maintenance favours setting this model within a historical framework to trace the shift in how one views addiction.  In chapter III I will conclude my thesis by demonstrating the changes that are currently happening within Irish policy and community development, changes that promote a more holistic model of care for the addicted individual within a social context.