Emma Kinsella didn’t think she really had a drinking problem in her 20s and, being able to stop as soon as she found out she was pregnant, convinced her that she couldn’t be an alcoholic.
She had enjoyed nights out at college but studied hard in between, determined to do well in her exams. She was always a bit of a perfectionist. “I had high standards and high expectations of myself in how I should perform in every area of my life,” she says.
After graduating from college in business studies, she got a job in one of the “big four” accounting firms in Dublin. There was a post-work drinking culture, but, after 12-hour days, she preferred to go home to relax – and treat herself to a bottle of wine.
Outwardly all was going well; she was passing her accountancy exams and getting good performance reviews at work. But inwardly, she was carrying mental scars of sexual abuse in her childhood. “It was a relative and I blamed myself a lot. I was only three when it started.” She thought everybody knew what was going on and they were all just covering it up, so she went along with that. In fact, her parents didn’t know.
She started self-harming before she was 10 as a way of coping and, a decade later, found alcohol had a similar effect. “It was turning off my emotions and a relief when I did it.”
Even if she sometimes felt her level of drinking was a bit worrying, she had no problem stopping “literally overnight” after a positive pregnancy test at the age of 28. She and her partner, having been living together for a year, were both excited about having a baby.
Emma didn’t give alcohol much thought from then on, with no hankering to resume. “I just focused on the pregnancy.”
Traumatic birth
But it turned out to be a traumatic birth, primarily because Emma had “horrific flashbacks” to when she was a child. She was holding her breath and the baby was getting distressed. Afterwards, he was okay and so was she – physically.
Lying in the maternity hospital, she felt like she was back in her childhood, thinking that people around her could see how traumatised she was, but were choosing to ignore it. In those circumstances, Emma wasn’t going to be the one to make a fuss.
Her baby, William, had to go into neo-natal care for a short while as his blood sugar was very low. “A big thing for me was that the breastfeeding didn’t work out. I was counting on it,” she explains. “I had read every book and I knew breastfeeding was best so I was going to find a way to make it work.”
I couldn't put words on how I was feeling or how overwhelmed I was
With the baby refusing to latch, she pumped her milk instead. But then she started throwing it down the sink, believing that formula would be better for him than anything that came out of her. “I knew what post-natal depression was and I knew it wasn’t normal,” says Emma who went to doctors and public health nurses looking for help in the early months. However, at appointments she didn’t disclose what was really going on in her head. “I couldn’t put words on how I was feeling or how overwhelmed I was.”
Nor could she tell them that she had started drinking again a couple of months after the birth. Consumed by anxiety when her partner went out to work in the morning, leaving her alone with William, she would be on high alert and stressed all day.
“The minute that he’d come home, I would just hand the baby over and lock myself away in a room and say I need some alone time” – and she’d drink. “Very quickly it started during the day time as well.”
However, alcohol no longer seemed to numb her feelings the way it used to and she drank more and more to see if it would. “Things just spiralled out of control very, very quickly.”
Treatment programmes
Emma, now aged 33, went into a psychiatric hospital when William was a year and a half. But, after six weeks, she discharged herself and started drinking again. That is when her partner left, taking William with him. “In hindsight, I don’t blame him; I am surprised he lasted as long as he did. But I fell apart completely – he was gone, William was gone and I was in this big empty house all by myself.”
That was August 2014 and for the next three years she was in and out of treatment – doing various programmes at St Patrick’s Hospital, seven months in Cluan Mhuire, a month at the Renewal addiction centre in Cork – but every time she got out, she would relapse. “The addiction was too strong; I was a nightmare patient,” says Emma.
While she had a dual diagnosis of mental health issues and addiction, she kept being told they couldn’t start to treat the former until she had her drinking under control. “I was extremely impulsive, reckless, self-destructive – a lot of that would be the psychiatric side of it but, because of those tendencies, I could never get sober long enough to begin the work that needed to be done.”
Since 2015, a psychiatrist at St Patrick's, Dr Marie Naughton, has, she says, been "the one constant in my life and she has not given up". Her recommendation of Coolmine Therapeutic Community's Ashleigh House in Damastown, Dublin 15, proved to be the turning point for Emma.
High-risk families
Ireland’s only mother and child residential treatment centre, it runs the Parenting under Pressure (PuP) programme, which was devised in Australia to help high-risk families with addiction problems. “The uniqueness of Ashleigh House is that it allows a mother to come into treatment with her child – either when pregnant or with a pre-school child,” says Coolmine’s chief executive, Pauline McKeown. Older children can also stay with their mothers at weekends or during school holidays.
While Emma came in alone last November, the centre immediately supported her in making access visits to William, whereas in other treatment centres it was like children were “put on the back burner”, she says. And further along in her treatment, he was able to come and stay with her at weekends.
The pretty, single-storey quadrangle of residential units, creche and offices behind a converted farmhouse accommodates 24 women and up to 17 babies and children under the age of five. But demand for the service far exceeds capacity, with more than another 30 women – 80 per cent of them mothers – currently seeking a placement here. “A proportion of those women who are waiting are pregnant,” says McKeown, pointing out that pregnancy is an opportunity to make a great change in these women’s lives, as it is a time they are highly motivated to seek treatment. But they need a place here to support them through that.
Although Emma was abusing only alcohol, most women coming in have also been using heroin and opiates, and prescribed medications. All are homeless, “coming from prison, from emergency accommodation, from couches of friends or family and, on occasion, from rough sleeping”, says McKeown. They are also likely to have spent time in prison or be facing criminal charges.
Most are stabilised on methadone before they come in. If they’re not pregnant, they start by detoxing off methadone and then do the rehab programme. “If they are pregnant, they come in on methadone and must stay steady on that for clinical reasons and they may detox after birth,” she explains.
An internal study showing that 80 per cent of those attending Coolmine’s addiction services come from homes where one or both parents were addicts, highlights how so many are caught in a generational cycle of chaotic lives.
Overall, it’s a five-month treatment programme for mothers with a young child, but seven or eight months for pregnant women who usually come in during their final trimester. However, the housing crisis means what should be a five to six-month inpatient programme stretches to nine or 12 months for these high-risk families, says McKeown, because there they have nowhere to move on to.
Attachment
When Ashleigh House started providing childcare in 2009, staff thought that was the key practical support mothers attending for treatment needed. Four years later, “we came to realise there was a whole big missing bit – attachment,” she says, between mothers and children. “The women were really struggling with their emotional management and the fact that they had the child in their care,” says McKeown. There is a lot of stigma associated with parents who are abusing substances, she points out, and they feel great guilt and shame about what damage they may have done to their children.
In looking for a parenting programme, Coolmine discovered PuP, the fundamental focus of which is secure attachment between child and parent. Conducted over 10-12 weeks, it incorporates group sessions and one-on-one counselling.
I really didn't see any value of myself as a person in his life
“When I was told I would be doing Parenting Under Pressure,” says Emma, “I just thought this is a programme for bad parents, to assess how much damage is done and correct it for the future. It is not that at all; it is more about celebrating your strengths as a parent.”
Up to that point, she had often thought her son would be better off without her. “I felt at least if I died when he was young he wouldn’t remember me. I had very dark thoughts along those lines – I really didn’t see any value of myself as a person in his life.”
She had fought through the courts for more access, but mainly because she thought that was what was expected of her as a mother, she admits. “When I did get access, I didn’t enjoy it. I felt he couldn’t wait for it to be over; that was all my own thinking, rather than the way things actually were.”
PuP turned this perception around, helping her realise that William’s time with her had huge value for him. “It showed him he did have a mother and a mother who cared for him.”
Safe space
In the group sessions, Emma found she was able to open up more with these fellow women residents than she had with any health professional. “It was a really safe space, completely free of judgment.”
She could be “totally honest” about “my lowest moments and the worst of the guilt that I carried about things I had and hadn’t done and times I hadn’t been there. Once you say these things, it takes the power out of them.”
A mindfulness component helped her accept that she couldn’t change the past and it was now about making good memories for William. “It is not about undoing the damage; it is about doing right from here on out.”
Emma believes that being around mothers and children all the time also made a difference. She identified so much with the thinking of the other women and realised that if she admired their strength and had great compassion for them, she should have some of that for herself too.
Ashleigh House started using PuP in 2014 and an independent evaluation by Trinity College researchers, which was published in September, found that 100 per cent of participants were substance free at the end of the programme. Dr Jo-Hanna Ivers and Prof Joe Barry also reported significant reductions in levels of anxiety, stress and depression among the parents, along with increases in mindful parenting and accessing social support.
Fathers
The study was carried out in 2017/18, during which PuP was extended to fathers attending a separate residential centre, Coolmine Lodge. A total of 23 mother and 10 fathers were surveyed before and after the programme.
Jack (who asked that his real name not be used) did the parenting programme while attending the Lodge for cocaine addiction. He is back out, in the “step down” phase, and due to go back to his job in a couple of weeks’ time.
“I learned tools and techniques in how to build bonds with my children and make amends,” says Jack, who now sees his three sons, ranging in age from seven to 17, once mid-week and every second weekend.
He has also been rebuilding a parenting relationship with his ex-partner. “She can see the work that am I doing on myself and ultimately being there for the children as well. Life is a lot better.”
While he says he never did anything through his addiction in front of the children, there were times he turned up late, or not at all, for access. “I wasn’t spending the time with them that they deserved – quality time.”
PuP is also available to parents attending day services in Coolmine House on Lord Edward Street in the city centre but additional funding is needed to “upscale it in the community”, says McKeown, who estimates it would cost about €108,000 for 12 months. “We want this piece of research,” she adds, “to inform Government departments and State agencies to adopt and agree a national roll-out of [the] PuP programme for homeless families affected by substance abuse.”
Place to call home
Meanwhile, Emma is sober for a year now. She left Ashleigh House in June, spent two months in a Vincent de Paul house before being “lucky enough to find an apartment through HAP [Housing Assistance Payment] where I am living now, which is great. The first time in three years I have a place to go home to.”
William, aged five, stays with her every second weekend and she also collects him from after-school care three days a week. She revels in their “really normal” mother-son relationship.
However, she takes nothing for granted, knowing the number of relapses she has had in the past. “I can’t afford to get complacent and I don’t. I do keep recovery at the forefront.”
He trusts me, and I never saw that day coming again after everything that has happened
While her former partner still has primary care of William, she says they are functioning much more as co-parents. “There is no question of any reconciliation, but we’re able to talk and communicate about the nitty gritty stuff, and even the more casual stuff of sending each other photos and videos and stuff. I do feel fully involved.
“He trusts me,” she adds, “and I never saw that day coming again after everything that has happened.”
