Sarah, a first-year college student, has been coming to me for counselling for several weeks. She is in deep despair, using addictions to alcohol and food to cope with daily life and the demands of her college course.
Once upon a time she had dreams of pursuing her passion for diving and wildlife conservation, and of tracking the migration of humpback whales around the world. Painting and making papier-mache whales kept the dream alive. Now though, these dreams are a distant memory, since she no longer potters or paints.
Her condition has deteriorated considerably since Christmas and continues to worsen. Sarah represents the one in five 18- to 24-year-olds whose drinking is out of control.
A 2013 report by the Health Research Board on alcohol use in Ireland highlights alcohol misuse as an increasingly serious problem among youth.
It reports that 44 per cent of young men and 39 per cent of young women aged between 18 and 24 frequently drink more than the recommended weekly guidelines (that is, more than 16 standard drinks a week for men and 11 standard drinks for women).
Most concerning, however, is the fact that this age-bracket exhibits the highest incidence of dependence (15 per cent), with increasing numbers of people under 30 affected by chronic alcohol conditions.
Binge-drinking patterns
Research shows that the level of harm caused by alcohol relates to the amounts taken and patterns of binge-drinking: in other words, the more consumed, the greater the risk to health.
Sarah shakes her head in disbelief when I explain that a binge means the consumption on one night of the equivalent of five or six standard drinks. She scoffs, saying “but that’s what I have for pre-drinks” – drinking cheap alcohol at home to save money before a night out.
Sarah regularly drinks a bottle of wine before going out. She tells me that once she starts drinking she can’t stop: over the course of a night, she knocks back shots of vodka and pints of Guinness, before heading to the off-licence to buy cans of beer and sneaking out with a couple of whiskey bottles stuffed in the belly of her jeans. Sarah calls this “crotch-walking” – the shoplifter’s trick of concealing items between her legs.
Youth binge-drinking is strongly correlated with alcohol dependence, which itself is linked to heightened risk of self-harm and suicide. According to a 2010 report by the National Office for Suicide Prevention WHO data, Ireland’s high suicide rate among 15-24-year-olds (ranking fourth in Europe) relates directly to patterns of excessive drinking.
Sarah frequently does not remember what has happened on nights out, is often unable to explain cuts, bruises and other injuries that she has sustained, has woken up in beds with strangers she does not recall meeting and has been found on the street by gardaí early in the morning.
Some nights, though, she says, she can sober up, at least enough to be able to teeter home on a “borrowed” moped on the wrong side of a busy road.
Sarah reports experiencing “sleep paralysis” where she wakes up, is conscious but cannot move and is terrified she will die. “The horrors” – that is, the pounding headaches, nausea, vomiting and feelings of anxiety that constitute her hangover experience – last a few days until she drinks again.
For a long time, she presumed that her inability to focus and complete college assignments is because she is “slow”. This is her fourth attempt at a first-year college course.
I am extremely concerned for Sarah and have told her from the first session that her life is at serious risk unless she faces up to the fact of her addiction.
Each week she sits opposite me and cries. Each week she comes back, reporting another litany of dangerous episodes, while insisting that she is not actively suicidal. Such is the strength of her urge to self-destruct that each week I wonder whether I or anyone else will see her alive again.
Her eating disorder symptoms are also intensifying: Sarah sways between lengthy periods of starvation and bouts of overeating. Last week she reported an uncontrollable binge on food, where she consumed everything in her housemates’ fridge and cupboards. She has since been evicted and is now sleeping on a drinking buddy’s couch.
Her doctor prescribed an anti-depressant. For a good while she believed this was the sole cause of the “noise” in her head, the blacking out and so was considering weaning herself off it. Had she relayed to the doctor about the amount of drugs and alcohol she was ingesting, I wondered. She had not.
Attacked at knife point
It has taken Sarah a long time to push through the wall of denial. Recently, however, she reached a crossroads. During a bender she was attacked and threatened at knife point. Sarah told me she couldn’t go on living the same destructive way, said she had told her family and that they are deeply concerned and keen to support her in accessing the help she needs.
In the interim, Sarah and her family have made calls to see what might be available in terms of inpatient treatment for her, but have met an impasse.
Economics has come against them. As a full-time student, Sarah does not have a medical card nor does her family have health insurance. This greatly impedes her access to support.
Refusing to accept what Sarah and her family had told me, I rang up several treatment programmes. The picture I got of the supports available in Ireland for people in crisis and with limited means was bleak. The fee for addiction treatment in a Dublin-based private hospital and in a separate private addiction facility, I was told, amounts to €27,700, which must be paid “up front”. This covers six weeks of treatment in the hospital or five weeks in the treatment centre. Aftercare is extra. I didn’t bother to ask how much.
All this would be laughable if it wasn’t so tragic. Firstly, it underlines the callous nature of our two-tier health system, which favours people with means and denies access to those without.
Secondly, the huge fees and brief timeframe reject the actuality of the addictive process. Part and parcel of having an addiction is that you are ambivalent about giving up the crutch that you have relied on to manage your life.
Part of Sarah believes she will die without this very dependable, although increasingly destructive, “friend”. It doesn’t matter that this “friend” has increased the unmanageability, damaging her relationships, controlling her thoughts, behaviour, ruining her life. I wonder just how many people in Ireland these days are in a position to fork out €27,000 to dance with this ambivalence.
The private hospital representative voiced genuine concern for Sarah and said that if she wanted to avail of outpatient treatment, that would of course be an alternative possibility. The woman told me it costs €200 for an initial assessment and €150 a session after that. I ended the call reiterating that as the prospective client was a student and had no money, she could not avail of this offer.
Life-saving treatment
A first-world country like Ireland cannot justify denying people access to crucial life-saving treatment. Have we become so inured to others’ pain that we put a cost on Sarah’s life?
Say you can afford private treatment for alcohol and drug addiction but have an eating disorder too. Most drug and alcohol treatment services in Ireland are based on the disease model of addiction, which claims that an addiction can be controlled but not cured.
A criticism levelled at this approach is that the focus of recovery is on treating the symptoms of addiction rather than its root cause. On the other hand, a holistic model of care takes account of individuals and their personal circumstances and respects their autonomy.
The staff at several treatment facilities around the country that I called regarding help for a young woman with dependencies on alcohol and food said they only dealt with drugs and alcohol” as if the substance is more important than the individual. This experience underscores the fact that we have created a divisive model of healthcare in which the predominant focus is on treating problems rather than people; simultaneously, it ensures that poor people’s problems do not count at all.
I called another private treatment centre that unusually, for Ireland at least, deals with both addictive illnesses and eating disorders. They said it would cost €5,520 for 30 days, or €184 a day.
This is evidently “cheap” in comparison with the other private rates quoted, but still way out of Sarah’s league. The final facility I approached offers a 28-day drug and alcohol programme that costs €6,804.
According to the counsellor there, the only avenue open to Sarah, given her lack of resources, is to attend the local HSE drug services and to be seen there for three to six weeks and then get referred on for inpatient treatment. Hope at last, I thought. However, when I rang the local drug service, I was told the HSE had “absolutely no resources” to fund Sarah’s treatment at this programme.
When I rang back and explained this to the addiction centre counsellor, he said if it was October, the end of the HSE financial year, he could understand, but it was March. “Of course they have the resources to refer her on to us,” he said,
Meanwhile, time passes and Sarah’s crisis is worsening. I talked to her the other day. She said she feels as if she is “losing her mind” and she sees no way out. I listened and told her there may be a possibility of getting into a treatment programme if she attended the drug service in town. I recommended she attend whatever 12-step programmes she could, use them as a lifeline.
“I dunno,” she said. “Maybe. I might.” I said she had to scratch the words might and maybe from her vocabulary and commit. This was about her life and about her fast track to death.
‘Do you remember that day you came in telling me about a lifesize model of a humpback whale you made for the marine science fair a couple of years ago?’ I said. “You were really excited about it and you were especially proud that one of the organisers had asked you back to help out again.”
“Yeah, I remember. It was really fun; I felt useful,” she said, with a wan smile. It was a flittering shaft of sunlight that enlivened the room before her eyes filled up again. “I can’t do this on my own any more,” she wept. “Please help me.”
Oh, to live in a society founded on the belief that if another human being asks for help in crisis, it’s given, without condition.
All identifying details have been changed.
Cristina Galvin is a psychotherapist and health researcher
