'It's about expecting good outcomes' — therapist reflects on 25 years of Adolescent Addiction Service
'While the heroin crisis of the 1990s was confined to Dublin, we are now seeing feuds in many rural towns and issues of indebtedness and intimidation affecting individuals and families,' says Denis Murray.
Denis Murray has seen it all over the past 30 and more years. Sometimes things turn full circle.
A family therapist working with the Adolescent Addiction Service which covers much of south Dublin, Denis sees echoes of a past era in the Ireland of today.
"It's very easy for young people to be groomed into carrying and holding," he says, referring to drugs.
"I worry about them now because we are in similar circumstances as the 80s. We are going to face a lot of issues of poverty — fuel poverty, food poverty.
A former toolmaker who "fell into" drug treatment in the late 80s, he estimates that he has assisted hundreds of adolescents over the years. In 2022, the Adolescent Addiction Service, which operates through the HSE, marked 25 years. In many ways, it is Denis' anniversary.
The service covers areas of the city such as Ballyfermot, Lucan, Clondalkin, and Cherry Orchard, where he has his office. It was born out of the heroin crisis of the 1980s, and while trends in drug use have emerged in the decades since, in many ways the story stays the same.
"If you go back to early 90s, young people were pushing at the door because they were in bits, they were highly dependent," he says.
Back then, the problem drug was heroin.
"Currently, with young people and drug use, it's a bit of an adventure, they are at the early stages of experimentation, it's part of their whole peer relationship. It's not as big an issue for them."
Until it is. Last year the Adolescent Addiction Service worked with 50 young people and their families. Those seeking help were aged 13-18 years and referrals were up by 25% compared with the figure for the previous year.
There was an 80% increase in the number of referrals to the service from CAMHS [Child and Adolescent Mental Health Service].
Cannabis/weed was used by 96% of those attending, with alcohol use down 15% to 54% of those seeking help. Cocaine was a feature in 16% of clients, and other drugs, such as benzodiazepines, ketamine, and amphetamines, were less prevalent.
This might seem like a far cry from the ravages of a heroin epidemic, but Denis has concerns.
As he describes it: "Where have we come as a society in terms of substance use with availability in every town and village access the country and alerts/offers coming through social media?
The dangers of a young person not just getting addicted to substances but becoming enmeshed in associated criminality looms large.
A "key time" in his professional life was the period of the so-called Canal Murders at the turn of the millennium, when two young men suspected of being drug couriers were killed. No one was ever convicted, but the shocking deaths brought an increased focus on the addiction service, with gardaí understandably keen to try to improve their information-gathering.
It meant Denis having to push back. He says he has huge respect for gardaí and the criminal justice system, but adds that he also has a responsibility to his clients.
"They were difficult times," he says now.
These days young people might be tempted to allow a bank account to be used to launder money. He welcomes the fact that school dropout rates have fallen and praises the education system for its openness in facilitating a chance of recovery for young people trying to overcome addiction.
He recalls how decades ago young people leaving care had little or no aftercare support and appeared drawn, inexorably, towards Dublin City centre, with homelessness and drug addiction a serious risk. That has improved, he says, as has the concept of tailored adolescent addiction programmes, detox treatment, and more.
When the service began back in 1997, he says, everything was working off a blueprint that served adults, when the challenges for young people were very different.
Other things change, but still reflect the past.
"If you came to this area 25 years ago, Liffey Valley [Shopping Centre] was not about, Park West [Business Park] had not been developed, you had an awful lot of free land, horses roaming wild," he says.
"People would jockey horses from different places, now they might run with scooters and electric bikes."
The cargo on some of those journeys is drugs.
Now, social media and mobile technology is in play.
"It's not a new phenomenon," he says. "It is just the mechanism that has changed."
He still has concerns, however. On a practical level, he sees the involvement of family — no matter how dysfunctional they may be — as something that should play a role, if at all possible, in the treatment of a young person using drugs.
Returning to the plight of some care-leavers two decades ago, he says the lack of those informal, family, or community, supports may have contributed to them falling into greater trouble. So he is apprehensive about discussion internationally of young people having a right to keep their treatment an entirely personal matter.
The statistics over the years from the service indicate a high level of parental separation for young people seeking help, but Denis believes that even in that scenario, two parents working together offer the teenager a better chance of overcoming their issues.
He recalls a story from some years ago, where the parents of a young person seemed somehow disengaged, but the grandparents stepped in. The grandfather tracked down the teenager, up to no good, at a free house somewhere in Dublin. "He knocked on the door, makes his presence felt, he goes into the garden and says: 'Come on, there's nothing good happening here'."
Another issue is what he sees as the growing tolerance towards cannabis use in Irish society.
A conference held last October to mark the 25th anniversary of the service heard a consensus from the various therapists and counsellors present "in regard to normalisation of substance use within society, especially when it comes to alcohol and cannabis/weed which is now available in many formats including cookies, muffins, jellies, and vapes containing tetrahydrocannabinol (THC), a psychoactive substance that is not registered for use in Ireland."
According to a report written about the conference: "Such a vape was presented to a family therapist within Adolescent Addiction Service last May which [a] parent had secured from their child and which upon analysis by Forensic Science Ireland contained only THC.
"In the circumstances, concern was expressed at the delay in early warning when it comes to emerging trends data in regard to substance use as well as the grooming of young people to carry, hold, and distribute drugs.
"Additional concern expressed about community breakdown, increased violence/intimidation, poverty, mental exploitation, and indebtedness, reflecting greater need for inter-agency working and of not pathologies human suffering, but to learn to dance with dual diagnosis and the need for consultants within CAMHS who have specific interests in addiction."
The report also referred to the challenges faced by services in responding to the needs of young people and their families, including funding, recruiting, and retaining staff as well as lack of support for frontline staff in dealing with issues including generational trauma.
Feedback from those attending suggested Tusla’s threshold for intervention "seems to be set too high as well, as CAMHS services closing/suspending contact with young people once substance use is identified and how young people experience this stepping back as rejection".
As for the legalisation debate: "In relation to the often-stated claim that if all drugs were legalised within society it would significantly reduce criminal activity, especially in relation to drug distribution, 49% of respondents disagreed with 21% strongly disagreeing.
"It was perceived by 88% of respondents that members of the general public get confused with terms such as decriminalisation and legalisation, and 94% of respondents expressed belief that young people can become confused with such terms.
"With regard to the call for legalisation of drugs within Irish society 82% were not supportive, with 6% not sure, and 3% didn’t answer."
Denis remarks how now, post-pandemic, he rarely passes through a train station without smelling smoke wafting from some direction, of people ambling around the street smoking a joint.
He has made a number of submissions in the past about decriminalisation, and on spent convictions, believing that young people should not be marked for life by their youthful drug use. But he believes new dangers — such as those imported cannabis vapes, harder to detect, even by the most helicopter of parents — illustrates the new ways that young people can develop a problem, and that legalisation would simply make matters worse.
Some of the young people attending therapy with Denis believe they may be "missing out" by not using or experimenting with drugs; he gets them to project forward, into their mid-20s, and looking back at an adolescence that could be marked by consistent substance use.
"It is about encouraging people to get a period of abstinence and get an understanding of themselves as a human being in society," he says. He refers to the Icelandic model, with an emphasis on social intervention, the role of families and communities, working with schools, as a way forward.
He has been at the other end too — once being with the family of a young man with a tumour which was present from birth but likely exacerbated by drug use, knowing he was going to die.
"It is about expecting good outcomes for young people," he says, maybe reflecting that past career as a toolmaker — wanting those seeking his help to make a better future for themselves.
CONNECT WITH US TODAY
Be the first to know the latest news and updates
