Dr Michael ffrenchO'Carroll's experience of the Irish social and medical scene stretches back to the 195Os when he worked with Noel Browne fighting the great scourge of that time - TB. To him a link between those days and today's running battle against what he sees as Ireland's contemporary epidemic - drug abuse - is as plain as night and day.
"Remember that once in this country we had a huge problem with TB and I remember exactly the same stigma. In fact, the situation was so serious that a TB allowance was actually paid to persuade people to come in for treatment."
Dr ffrench-O'Carroll, who now works as an addiction consultant to the Cuan Mhuire Centres run by Sister Consilio Fitzgerald, is the author of The Irish Drugs Epi- demic, published this month, in which he articulates his belief that, taken together, alcohol and drug abuse is the major medicosocial problem in this country today. And the link to alcohol is crucial to his philosophy. To him drink and drugs are far from being two separate problems, though some may not initially see the connection.
Some 75 per cent of 12 to 18year-olds are using alcohol, and among teenagers alcohol and drug abuse are interlinked - the former often acting as the gateway to the latter. "What's happening with teenagers is that the quantities of alcohol they're taking are enormous. We're dealing with teenagers consuming alcohol in quantities which would be abusive even for adults."
Dr ffrench-O'Carroll was appointed Director of Community Care and Medical Officer of Health with the Southern Health Board in 1976. In the early 198Os, he established a treatment centre, Arbour House, a separate unit for alcoholics in St Finbarr's Hospital, Cork. He also gave seminars in Cork schools about alcohol and drug abuse, but was disappointed with the response from parents. only about 2O per cent turned up to evening seminars.
Dr ffrench-O'Carroll has studied in the University of Michigan Medical Centre and has worked in the United States on a number of occasions. Young people there have to be 21 to buy alcohol, and bar staff, he says, are careful to check identity cards because bars can lose their licences for selling to minors. In Ireland the Intoxicating Liquor Act 1988 empowers the Minister for Justice to make regulations providing for a national voluntary age-card scheme to help to curb the supply of alcohol to persons under 18. But according to Dr ffrenchO'Carroll, identity cards have not come into practice because parents never demanded it.
"The situation in licensed premises generally is much too lax where the verification of the legal age is concerned. The licensed trade should have much more accountability. If a licensed premises serves alcohol to someone under age, they should be warned on the first occasion, on the second there should be some period of suspension, and where there is a third and fourth violation the licence should be withdrawn."
Dr ffrench-O'Carroll has an MD in Community Health from Trinity College. He has a particular interest in Epidemiology, the pattern of diseases in a community. The approach he adopted in his Arbour House project in Cork was based on methods used at the Hazelden Foundation Treatment Centre in Minnesota. Those taking part in the programme were assessed and treated at four levels, physically, psychologically, emotionally and socially. Before young people were accepted for treatment they had to stop taking alcohol and drugs. But they also had to break away from peers and places which encouraged abuse.
The typical teenager treated at Arbour House was someone who had passed their Junior Certificate exams. But because of abuse, mainly of cannabis, they would start to miss school, performance would decline and they would either fail their Leaving Cert or drop out before that.
While the young people in Cork came from all areas, from the richest suburbs to the deprived housing estates, Dr ffrench-O'Carroll says: "Addiction is predominantly a problem of poverty. The young people I am talking about who are abusing alcohol and cannabis in areas which are socially deprived find themselves, when they drop out of school at 15 or 16, in an absolutely hopeless position.
"They're not capable educationally of further training and rehabilitation. They're going to need active treatment. Unless we're able to respond to the needs of these young people after they have been treated successfully, you're going to have a huge increase in young people who are illiterate and not only unemployed but unemployable."
He believes addicts in the middle and upper-income groups have more resources for dealing with the problem. They don't have to resort to crime in the same way because of their financial position and can get private treatment and rehabilitation.
Parents usually find out about a teenager's addiction when a garda calls to the door. That may be three years down the road. Teenagers are much more knowledgeable about the effects of alcohol and drugs than parents, who don't have the information or the skills to penetrate this underworld. In his book, Dr ffrenchO'Carroll tells the story of how one family found out about their son's addiction.
"John (18) borrowed the car one night on the pretext of taking the dog for a walk on the beach. Instead, he drove there with three friends. They spent about two hours smoking cannabis with the windows closed up in order to get a better buzz. The dog was locked in the boot. "When he got home, his father , worried about the dog, discovered him still in the boot. He wasn't able to walk so they took him to the vet and found that he was intoxicated on cannabis fumes and had traces of it in his bloodstream.
"It may sound bizarre, but at least one family were thus alerted to a problem in its ranks that previously the parents had no suspicion of whatsoever."
Often, however, the situation is exacerbated by the fact that parents may have problems of their own, including marriage difficulties, as a result of their own alcohol abuse. They may need help as much as their children.
There has, he believes, to be accountability on the part of parents. "if they're going to be involved in alcohol and drug abuse themselves, they can't expect their children to do otherwise.
Now based at the Cuan Mhuire branch in Athy, Co Kildare, he has been studying the drug problem in Dublin where methadone - which, he believes, should be a last resort - is used in response to heroin addiction. He believes drug-free treatment should be the first option and cites US studies which show that an addict had to be receiving methadone daily for four-and-a-half years in order to break a drug habit. Findings also showed that during the methadone treatment programme a high proportion of addicts continued to use alcohol and cannabis.
Methadone has now become a street drug so that like tranquilisers some years ago we have methadone coming from legal and illegal sources. It's a very serious situation, that parents, because they can't get to professionally operated detoxification facilities, are going out and buying methadone themselves in an effort to detoxify their own sons and daughters.
Dr ffrench-O'Carroll believes the Government should respond by providing a comprehensive programme for the whole country which would involve prevention programmes in primary and secondary schools and in the workplace and early intervention in communities where prevention has failed. Prevention and intervention need to be backed up by out-patient treatment facilities and rehabilitation in all communities throughout the country.
"It's going to cost money, but the money involved in the provision of these services is very small compared to the cost of the social implications of untreated addiction for the whole nation."
Because of the role alcohol plays in Irish society and culture and the spread of drugs, Dr ffrenchO'Carroll believes that it's a medico-social problem which demands a parallel response involving the Garda and the courts along with the medical and social services.
The Irish Drugs Epidemic by Michael ffrench-O'Carroll is published by The Collins Press, Cork, at £6.99.