If you walked into an addiction service 25 years ago – when I started working in Chrysalis CDP, a Dublin community drug project – the work looked very different. Heroin dominated the scene; the focus was on reducing harm and crisis management– dissemination of harm reduction information and materials, needle exchanges, methadone programmes and outreach services in the inner city. The people using drugs were mainly young males from deprived areas. Services worked hard but the focus was more on the drug itself than the individual.
25 years later, addiction work has changed drastically. Frontline workers now face a much more complex landscape – not only in the types of drugs being used but also in associated issues such as dual diagnosis (co-occurring mental health and substance use disorders), homelessness and other social issues. A complex picture that reflects Dublin’s social and cultural shifts.
From Heroin to Polydrug Use
In the late 1990s and early 2000s, heroin was at the centre of Dublin’s addiction crisis. Injecting was common, and the risks were high – HIV, hepatitis C, and overdoses. Services such as Anna Liffey Drug Project and Merchants Quay Project led the way in harm reduction. Today heroin has been overpassed by other drugs such as benzodiazepines and cocaine use, polydrug use has become the norm. Cannabis is ever present. Many service users are using alcohol, prescription medication (not always prescribed) and illicit drugs together, often to numb emotional pain or cope with trauma. There is also a rise in behavioural addictions like gaming, gambling, sex addiction, again unhealthy coping mechanisms to address deep-rooted mental distress. Addiction is no longer a single-substance story.
Seeing the Person Behind the Addiction
One of the biggest shifts in the past 25 years is an understanding that behind every addiction there is a person and a story – often of adversity, neglect, violence and, or loss. Instead of saying ‘why are you behaving in this way?’, addiction practitioners are asking ‘what happened to you?’. Many people presenting to services in Dublin Inner City have experienced multiple layers of trauma from childhood abuse, homelessness, domestic violence, untreated mental health conditions to name few. Some have also lived with the intergenerational impact of poverty and substance use.
A Changing Addiction Sector and Philosophy
Addiction work in Dublin has become more holistic and collaborative – statutory, voluntary and community services working alongside each other to facilitate better outcomes for the service user. Staff are trained in trauma-informed practice to avoid re-traumatisation and to promote safety, dignity and self-efficacy. Due to the complexity of the work, frontline staff are also trained in mental health support, neurodiversity and family work.
However, the challenge remains substantial. Polydrug use and dual diagnosis are on the rise. Homelessness is also on the increase. Waiting lists persist, and stigma still blocks many to reach for support. Yet the shift towards trauma-informed and person-centred care has changed the culture of addiction work to a more compassionate approach.
Looking ahead
After 25 years, we have now accepted that addiction is not just about the substances or behaviours, it is about people and their life stories – it is about pain, trauma but also about resilience. It is not about the ‘them and us’, the ‘deserving and not deserving’, it is about people with different journeys, whose stories need to be heard, valued and acknowledged. Addiction is no longer seen as a person failing but as a response to pain and trauma.
The challenge for the services is to continue to be adaptable, responsive to emerging needs, compassionate and connected. From heroin to polydrug use and behavioural addictions, Dublin’s addiction landscape has changed significantly – and services are now addressing not only the new drug trends and addiction patterns but also the social and psychological roots of addiction, trauma.
Primary Image credits: Chrysalis CDP
Passerose Mantoy
CEO
Chrysalis CDP
Passerose Mantoy
Passerose Mantoy is the CEO of Chrysalis Community Drug Project, a community-based drug and alcohol service operating in Dublin’s North Inner City. Her training and qualifications are in the areas of counselling, supervision, leadership and community development.
Passerose has worked in addiction services for the last 25 years; the first ten years as addiction practitioner, and fifteen years as CEO of Chrysalis CDP. She is an accredited addiction counsellor and clinical supervisor. She believes in a person-centred and trauma informed approach, the voice and choice of the service user being central to the model of care of Chrysalis.
As CEO of Chrysalis, she has publicly commented on the deteriorating situation in Dublin’s North Inner City e.g. rising complexity in addiction cases, and the need for compassionate, comprehensive support for individuals seeking help.
Passerose has a particular interest in Public Health and Engaged Research.
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