The drugs don’t work

The number of cocaine users in Ireland rose significantly in 2020 compared with 2017. Mary Hallissey speaks with Emma Kavanagh, clinical services manager at Dublin’s Rutland Centre, on the prudence of seeking help for addiction.

Drug use in Ireland is creeping ever upwards, together with escalating mental-health difficulties.

The Rutland Centre treats 160 patients for addiction each year. Its head of clinical services, Emma Kavanagh, comments: “There is a real crossover between addiction figures and mental-health figures – the figures are linked.

“A large proportion of people presenting for drug treatment also have some sort of mental-health diagnosis or are consistent with mental-health symptoms,” she adds.

Those with addictions may also be on psychotropic medication, with dual-diagnosis extremely common. “It’s very difficult to know which comes first,” says Kavanagh. “It’s a convergence.”

This means that the full extent of addiction isn’t necessarily accurately recorded in statistics, since mental-health services may be dealing with many of those cases. The Health Research Board reports a massive increase in cocaine use in this country: 2,600 people presented for treatment for cocaine addiction in 2020, up from 1,500 in 2017.

“Cocaine is certainly problematic and is becoming more problematic as the years go on,” Kavanagh says.

Slide away

Cocaine is certainly deeply problematic for anyone using it in the legal profession, since it’s a stimulant that speeds up the central nervous system, inflating confidence while deflating any sense of risk. This leads to very poor decision-making, because the ability to weigh risk is impaired by the narcotic. If lawyers don’t have good judgement, what’s left?

Statistics from 2020 show a 9% decrease in the number of drug-users entering treatment, but cocaine use continues ever upward. An estimated one-quarter of all drug-users presenting for treatment will be on cocaine.

“Only a small proportion of people using cocaine present for treatment,” says Emma, meaning that the number of those using is likely to be exponentially higher.

Dealing with addiction is messy and complicated, she says.

With qualifications in psychology, psychotherapy and addiction counselling, Emma Kavanagh has worked at the bleeding edge of drug use in this country for many years. She heads up all clinical programmes at the Rutland, as well as outpatient and aftercare, and some operations and governance work.

“You need to be abstinent from a substance before you come in,” she explains. “It’s very much psychological work that you do when you come into a residential treatment centre.”

The most severe cases are treated as in-patient residents at the Rutland, in Dublin 16.

Catching the butterfly

One big barrier to accessing residential treatment is the scarcity of medically supervised detox beds, which Kavanagh describes as “a big gap”.

It’s very dangerous to go ‘cold turkey’ with alcohol, for instance. Medical supervision is always required for physiological withdrawal, and Librium will often be prescribed.

Coming off prescribed medication, such as benzodiazepines, can also cause severe difficulty, or even fatal convulsions. While ‘benzos’ are often GP-prescribed, there is also a huge black-market trade, Kavanagh points out.

“And opiates are really, really addictive. We have a long-standing opiate problem in Ireland,” Kavanagh says. Detoxing from opiates may require using a substance such as methadone, and can take a significant amount of time.

The Rutland takes both privately insured and public patients and offers assistance programmes for those in financial need: “We would hate for money to be the barrier for people in accessing treatment,” Kavanagh says.

She is fully aware that for those with demanding jobs who are tipping over into addiction, a five-week in-patient programme maybe too much of a commitment.

Outpatient treatment is also available, with a commitment to two group-therapy sessions, and one in-person individual therapy session, each week.

“That can be really suitable for individuals who are unable to take extended periods of leave from work,” Kavanagh explains.

Space and time

Generally, people who do well in the outpatient programme have good support systems at home, are living with a family member, and have been able to maintain a period of sobriety on their own. Outpatient treatment can also suit ‘binge’ users, Kavanagh notes.

“We always say to people it’s really a year and five weeks. While the residential treatment takes five weeks, you are required to sign up for aftercare, which runs for a year, so really you are with us for a year and five weeks, minimum.”

Many people go on to do a second year of aftercare as well, and the prospects for a sustained long-term recovery are greatly enhanced with lengthy follow-up.

The duration of treatment will depend on how functional the person is, and the severity of the presentation. Some people may still be able to work right up until coming in for treatment. But it’s tough, intense work.

“Psychologically, you’re going into a very deep, very vulnerable place,” says Kavanagh. The goal is to figure out the cause of the addicted behaviour, and to answer the question of what function the addiction is serving. “When someone enters recovery, it can be an amazing thing, but it’s a change and change is difficult,” she explains.

This time

Addictive behaviours may be carried into sobriety. The work of early recovery is to look at the maladaptive behavioural patterns, such as secrecy or manipulation, that sustain an addiction, Kavanagh continues.

“There’s a real difference between being sober and being in recovery. Recovery isn’t about just putting down the substance. It’s about looking at the function that the substance served, and making changes towards being a healthier, more well-rounded person,” she adds.

There is a high correlation between those who have been traumatised and those in addiction. A big focus in recovery is finding the function of drug use in that person’s life, Kavanagh points out.

“People want escapism, they want to soothe at some unconscious level. Addiction is soothing. It’s a balm. These are the reasons why people use, because of psychological pain or an inability to cope with what’s coming up in the present.”

Kavanagh is an advocate of therapy to get to ‘know thyself’ better, and thus to become better equipped to face the world. “You don’t have to be broken to do therapy,” she says, praising the Law Society’s psychological service, which is available to all Blackhall Place trainee solicitors.

Rather be

She believes that there are opportunities for earlier interventions and greater awareness, and for offsetting some of the things that correlate with addiction, such as adverse childhood situations.

Cultural markers are strong around alcohol in this country, and Kavanagh believes that legal leaders should put effort into breaking those associations.

“Instead of rewarding closing the deal with boozy nights out and boozy weekends away, maybe staff should be rewarded in different, healthier ways. That would be a good place to start.

“I’d like to see a greater emphasis on promoting a more well-rounded workforce and not one that delivers on deadlines, regardless of the impact on themselves.

“I’d like to see rewards for those who turn off their laptop at six o’clock and take care of themselves, and not just for those who stay back and work every hour.”

Younger generations are learning a different language of self-care, Kavanagh believes, and they will bring that into adulthood and the professional sphere as well.

Ultimately, better psycho-logical health in the nation is a key factor in reducing the impact of addiction.

Bitter sweet symphony

“People who develop problems are not bad people,” Kavanagh concludes, warning that dealing in stereotypes can mean we miss difficulties in those right in front of us. People who come to the Rutland could be your neighbour, your sister, your mother.

“They’re professional people who have lovely, loving relationships, who have good careers and, for a variety of reasons, they find themselves in this really horrible place where they’re relying on substances to feel okay.

“No one sets out wanting to be in addiction. It’s teeny-tiny steps and teeny-tiny risks, and the links are so small that you don’t see where they’re headed. And those steps are hard to quantify because they’re different for different people.

“Often, they’re not feeling great, they’re isolated, or they’re feeling lonely. Generally, there’s a feeling somewhere, and that’s what’s leading us to take that little behavioural step.

“So, the more we can be in touch with ourselves, the more we can take care of ourselves on an emotional or psychological level, then the less likely it will be for us to act out in a way that’s not authentic or healthy for us.”

DANGER SIGNS

What do you do if a colleague begins behaving erratically? And what are the signs of drug abuse?

Changes in behaviour may indicate problem drug use or alcohol use, says Emma Kavanagh. This could be a different routine or approach to work. Fluctuations in energy levels could be indicative of an addiction issue, particularly as cocaine is a stimulant.

“When people are using it, they will be very high-energy and manic. And when they’re not using it, they will slump in the aftermath of that.

“Increased socialising is often associated with cocaine or alcohol use. Pushing the boundaries and wanting to keep going all the time – the user doesn’t want to go home.

“A really common behaviour associated with cocaine use is to be in and out of the toilets all night long, and disappearing for periods of time.

“Physical symptoms include enlarged pupils, bloodshot eyes, and strange jaw movements.”

Behaviour

Absenteeism from work over a prolonged period, particularly Monday mornings or around paydays, is also a sign.

If concerned, a colleague could tentatively ask a question. Or point out factual matters without becoming accusatory.

“Keep it factual and specific, and ask ‘are you okay, because I’ve noticed changes?’” she suggests.

But be prepared for a defensive reaction, and don’t push the conversation into a place that’s hard to come back from, she advises. Denial is a core characteristic of addiction. “Disengage and say: ‘look, I can see that you don’t want to talk to me about this right now. We can leave it and come back to it later’.”

Escalating upwards

Then, it’s about escalating it to someone more senior, who has the authority to take it to a more formal level where there can be consequences and a thought-through managed approach, she says. This may be the HR department, which should have a drug-use policy.

She warns that a person’s drug use may be too much for a watching colleague to carry alone. It’s unfair for a bystander to be left holding the problem and feeling responsible if the colleague ‘drops the ball’ on an important case.

“I think it’s important that people don’t hold the problem on their own, and that they go and seek support – for their own sake.”

But going to HR can be seen as ‘snitching’, and what if the HR department hasn’t inspired confidence to date?

“Absolutely, and people are very reluctant to do it. But it’s about trying to ‘play the tape forward’ and tease out the consequences of not saying it. Doing nothing is very rarely the solution to the problem. You might feel it’s snitching, and the person might be upset with you, but in the long run, they get the help and support they need.”

Consequences

While an addict might not be ready for help, Kavanagh says that consequences, boundaries, and understanding the effects the drug use is having on their lives will move them to acceptance.

She points out that the level of responsibility held by those in the legal field probably creates an ethical obligation in these situations: “If someone in the legal profession is not of sound mind, that probably does need to be flagged,” she warns.

However, she accepts that not every HR department may be correctly equipped to deal with these situations: “There is never an easy or neat way to bring this together. It’s always a difficult subject.”

However, a direct link with the family of a colleague in trouble can make the situation easier because, generally, the family will have been aware of the problem long before the employer or the workplace is affected.

Kavanagh accepts that there are some people who will never want to engage with rehabilitation services, but she believes that it’s an extremely small percentage.

Regardless of whether someone is ready to stop using, linking with a professional is advisable, as there are other harm-reduction supports available too. Most people will engage when the consequences mount up,” says Kavanagh.

“Addiction is tricky, it’s complex, it’s insidious and, for some people, it will take a long time and a lot of consequences for them to finally admit that something needs to happen.”

Read and print a PDF of this article here.