From the four neatly made beds, a pair of runners placed together on the floor under the window sill and clothes hanging tidily in the open-fronted wardrobe along one wall, you’d never guess it is a teenager’s bedroom.
Nor is the living room downstairs, with its decorative, plastered ceiling and elegant large windows framing views of the flooded river outside, a typical hang-out for adolescents. But the sense of calm in this country house built in 1788, which later served as a convent, is exactly what its current young residents need.
In the corner of the living room, identical, blue-covered copies of Narcotics Anonymous stuffed into an array of cubbyholes are a reminder of where these teenagers are coming from.
This is Aislinn, the only residential addiction treatment centre in the Republic for adolescents as young as 15, up to the age of 21. And last year it opened the country's first detox unit for that age group, Lá Nua, in an adjoining building.
Located on the outskirts of the Co Kilkenny village of Ballyragget, the complex is in a tranquil setting beside the River Nore. A "serenity garden" has been created in the grounds, with structures representing each of the "12 Steps" on the journey to recovery from addiction.
Managing chaos
The initial aim is to take the chaos out of the lives of the young people referred here. Although they come from a variety of backgrounds, each lifestyle has typically been one where night is day and day is night.
They are used to being constantly on the alert – for the next fix, the Garda and individuals to whom they owe money. Eating has generally been reduced to grazing on takeaway foods.
Last week the Aislinn centre opened its doors to a group of health professionals working in drug addiction in the southeast, along with The Irish Times , to give an insight into the process the young addicts undergo here.
They are referred from all over the country, through HSE services, the Probation Service, GPs and families.
The road to addiction usually starts with a can of beer, at maybe as young as eight or nine years of age, says Aislinn team manager Ian Doyle. "Some of that may be out of peer pressure, or they have observed it at home, and some of it has to do with advertising," he says.
Next it’s vodka; then there are people who are happy to supply them with cannabis free of charge . . . and “it can go terribly pear-shaped from then on”.
Whatever the pattern of their substance abuse, Aislinn is seeing more and more young addicts with complex mental health issues, he reports. This raises the chicken and egg question: have these issues driven them to abuse substances or has the abuse scrambled their still-developing brains?
For some, their stay will begin in the detox unit, while others, who present with clear urine tests and are adjudged to be in “the right head space” for rehabilitation, go into the standard six-week programme. But all are enveloped in a welcoming regime of timetabled activities, with a sense of routine and community that may be alien to them.
Aftercare programme
Individual care plans are worked out for each with an eye on the next and often more difficult step of returning to where they came from. The residential programme may be just six weeks but there is a two-year aftercare programme to try to keep them on track.
Aislinn operates at full capacity most of the time, with 12 beds in the main house and another four in detox. As soon as a place is vacated there are other troubled youngsters waiting to fill it – the majority boys but girls attend too.
Criteria for admission include incidences of loss of control, increased tolerance of addictive substances and that the person appears ready for change, explains Emer O’Shaughnessy, who is in charge of assessments. Once a client is approved, “it is about putting a plan in place to keep them safe until we have a place in the house”.
When it is not practical to attend weekly pre-admission meetings in the centre, she links back to whoever referred the youngsters, to organise a “holding” arrangement.
Those referred for medicated detoxing in the nurse-led Lá Nua unit are assessed on admission by local GP Dr Miriam Hogan who, along with visiting consultant psychiatrist Dr Bobby P Smyth, supports Aislinn's multi-disciplinary team of 22 staff and six part-time workers.
Detox can take between one and four weeks, depending on whether it is opiates, benzodiazepines or alcohol the person is being weaned off, and the process may be speeded up or slowed down according to the individual’s response.
Physical withdrawal symptoms vary but could include paranoia, hot and cold flushes, itchy skin, palpitations, night sweats and day sweats. “But because it is a medical detox, they are given something to make it as comfortable and as safe as possible,” says Doyle.
Talking through withdrawal
The other side of withdrawal is the psychological craving. There is no medication to stop this, which will continue after the physical symptoms have gone, he explains, "but we get them to talk this through".
Sleep and nutrition issues are addressed as soon as they start detox but counselling will come later. However, “as the fog starts to rise”, says Doyle, the youngsters are given opportunities to start looking at what they are dealing with.
The strength of Lá Nua is that it is a “very safe space”, says Doyle, and detox clients don’t mix with the larger group in the main house. A row of four hospital-style beds, each in a curtained-off cubicle, open up into a common eating area, a kitchenette and relaxation space, with a bathroom behind, and a glass-fronted office for a nurse and care assistant who are rostered there around the clock.
When we drop into the unit, its residents, two aged 16 and one 17 (a fourth, says Doyle, “decided it wasn’t for him” a couple of days ago), are attending art therapy in the main building. But they cheerfully breeze in the front door with paint-stained hands just before we leave and head to the fenced-off back garden to light up cigarettes in one of several gazebos dotted around the grounds, as smoking is banned in all the buildings.
Down in the basement art room, clients’ creations are scattered across the benches. Rows of painted clay faces tell their own stories: some with blank expressions, others grotesque; in one a tongue is stuck out, on another a tear rolls down the cheek, while a pretty, pink and vibrant one could have been made only by a girl.
They are "very revealing", says art tutor John Davies. "It is a momentary glimpse in opening the door."
Twice-weekly art therapy is one of many activities for those on the six-week programme. Clients, who must be downstairs, dressed and ready for breakfast at 8am, each have a key worker and sign a contract of behaviour at the start.
A notice on the wall in the hall outlines seven grounds for “immediate dismissal”, including possession of alcohol or drugs, bringing in or use of a mobile phone and an act of intimacy with any resident or staff member.
Their days are taken up with one-to-one counselling and group work, educational talks, recreational therapy, psychodrama and meditation – just staying still can be a challenge.
“Lads are not able to be with themselves,” explains senior counsellor Jo O’Meara. “They can’t sit on a chair for five minutes.” They may also lack social skills, such as not knowing how to lay a table, or even sit down and eat a meal with others.
On Wednesdays, family members, for whom the young people's "time out" at Aislinn can be a welcome respite, attend. The adolescents are encouraged to face up to how their addiction has harmed loved ones and steps are taken towards repairing relationships. (Aislinn also offers a separate, residential respite programme to families affected by chemical abuse, in Croí Nua, a four-bedroom bungalow in the grounds.)
Focus on coping skills
Relapse prevention is another important component of the adolescents' programme, focusing on coping skills for when they leave.
“They may feel they have changed but life hasn’t – their home hasn’t changed, their community hasn’t changed,” says O’Meara. This is why staff explore whether returning to school or starting a training course are options. “There’s no point in them going back to the same chaos.”
People constantly ask Doyle what are Aislinn’s success rates. “I think what they are asking is are they clean, are they sober or are they using and drunk? And they judge it in that sort of way and I understand that,” he says. “I think there is some value in that but it is not the fullness of the story.
“The clients that we have here haven’t made the best of choices in their lives and what we’re trying to do is to work with them, to get them into a place where they can start making life-giving choices for themselves.”
For Aislinn staff there is short-term, medium-term and long-term success, he explains. Paul’s story (see panel) is one example of long-term success.
“He did the work, we only facilitated it. But to be a part of that is an extraordinary privilege,” says Doyle.
Shifts in attitudes
Medium-term success is seeing shifts in clients' thinking and attitudes, their fears abating, as they work on their grief and anger, recover self-esteem and regain a sense of hope.
“Short term, it’s the physicality,” adds Doyle. “You see them coming in, particularly into detox, emaciated, their complexions grey and wan. Within a week you can see their eyes and colour change, they put on a bit of weight – it’s extraordinary.”
Ten months ago Aislinn amalgamated with the Aiséirí group, which runs adult addiction treatment centres in Wexford, Waterford and Cahir, Co Tipperary. After a period of reorganisation, the Co Kilkenny centre will launch a new strategic plan for its services on March 31st.
Securing adequate funding to keep the place running is the biggest challenge, says Aiséirí 's head of services, Breda Cahill. Aislinn's annual budget of €1.7 million comes from the Health Service Executive, the Probation Service, private health insurers and fundraising.
For those whose lives have gone awry so young, the second chance they’re given at Aislinn is priceless.
As the testimony of a former resident, Jane (19), put it: “The staff and peers have helped me see that life can be brilliant without drink and drugs, and when I go home nothing will have changed apart from me and that makes all the difference.”
For more information see aislinn.ie
swayman@irishtimes.com
Paul’s story: the rocky road to recovery
Paul’s problems began “with a few cans up the lane” at the age of 13. “I knew the moment I drank the first drink that it was something I wanted to do again.”
Within a few years he was losing interest in school because any money he could get he spent on drink. Half-way through fifth year he left to go into an apprenticeship. He quit sport too because soccer on Sunday mornings after the night before was out of the question.
Although he smoked a little hash at the age of 14, he did not progress to harder drugs until later. He did most of his drinking from Thursdays to Mondays but it became increasingly hard to stop.
By the age of 20, he was living away from home, and "physically my body was beginning to suffer as a result of the drink and the drugs".
Eventually he went to a doctor looking for medication, but maybe also “hoping to be caught”. He felt suicidal: “I hated who I was and didn’t think life was worth living.” The doctor referred him to Aislinn.
The first day there he was “very frightened” and didn’t think he would make it through the programme. He had tried giving up alcohol a few times himself – even asking his parents to lock him into his bedroom one weekend – but without success.
Over the weeks at Aislinn he was “slowly introduced to a different type of life”. Although staff impressed on him the importance of the aftercare, on leaving he thought the hard work had been done.
“But I really struggled badly the first weekend.” He couldn’t wait to return the following Tuesday for the first of his weekly aftercare meetings.
He recalls a sense of anger over the following months at not being able to drink any more. “I felt I had been robbed of something.”
Paul reckons he caused his parents just as much stress during his first year of recovery as before, by regularly threatening to go back on the drink. “I was hurting.”
He went running every day after work and took up martial arts to fill the void. The aftercare programme really helped, he says, because he had friends of the same age with the same difficulties on it.
His "old school" father, who didn't talk about feelings, faithfully went with him to all the aftercare meetings, "and it changed him too", says Paul. He learnt how to deal with his son through the bad patches.
Now married and living in Co Laois, Paul has two young children and is enjoying a science course at college. Back in Aislinn last week to tell his story, he adds: "The one thing I had coming out of here was hope – that my life could be different than it was."
Adolescents and substance abuse: handbook on information and guidance
Any professional working with teenagers in Ireland today is bound to come across substance abuse at some point in their work.
A new handbook, Adolescents and Substance Use (Radcliffe), offers information and guidance on the topic which, its four Irish authors argue, is different from the adult equivalent for many reasons, not least because the brain is not fully mature until the age of 22.
Psychiatrist Bobby P Smyth, psychiatric nurse Philip James and psychotherapists Caitr íona Kearns and Ann Campbell have drawn on their collective professional experience to produce a very readable and practical manual.
