Former addict Martina Keoghan credits a community drugs rehab programme with saving her life. But as the National Drugs Strategy comes under review, there are fears of cutbacks, reports Kitty Holland
The 15-year heroin habit was bad enough, but almost two years on cocaine stripped Martina Keoghan (40) of everything. "I lost the respect of my kids, my looks, my health," she says.
By the time she began a foundation education course 18 months ago at SAOL, a Dublin community programme for women recovering from drug addiction, based in Amiens Street, Keoghan weighed less than six stone. To raise the €200 a day she needed to buy the cocaine she injected into herself four times daily, she had "gone out on the street". She had suffered assaults and rape, and assumed that "no one would ever want to give someone like me a hope".
A mother of three grown-up children, Keoghan sits in the private counselling room at SAOL (Seasamhact, Ábaltacht, Obair, Léann - or Stability, Ability, Work and Learning). She explains it was an attack by a client "on the street" which made her feel "something had to give". A man had driven her to Phoenix Park, and when she refused to perform oral sex without a condom he had smashed her face against the steering wheel of his four-by-four Jeep.
The attack shattered the main bone of her nose, and it still shows slightly. "He left me in bits," she says. "I just got so frightened and I suppose that began to bring me back to my senses. The kids were saying either I sort myself out or they were going to leave. To hear that, it's very hurtful."
Cocaine is a far more complex drug to give up than heroin. "It's a horrible drug, does horrible things to your mind," says Keoghan. "It's the complete complete rush and you just gab, gab, gab, talking non-stop and saying things and adding things on that didn't even happen. I did things I never thought I'd do to get cocaine."
As a psychologically rather than physically addictive drug, cocaine has no equivalent to methadone, the synthetic opiate used to treat heroin addiction. Keoghan was hospitalised to clear the drug from her system and it was then that her doctor suggested she approach SAOL. "I thought it was mad," she says. "Who'd take me? I wouldn't have taken me on. But I did the interview here. Then they rang me and told me I was to be in on Monday at 10 o'clock. I just said to them: 'You are going to give me a place?' I couldn't believe it.
"When I asked Siobhan [ Cafferty, her key worker] why they took me on, she said: 'Well, I just listened to you and looked into your eyes, and I knew that if we didn't get you in you were going to be dead within six months."
Asked what SAOL has meant to her, she sits forward, her eyes brightening.
"Coming here, well, just someone cared. And someone showed me a bit of respect," she says.
Pausing, she closes her eyes slightly, then adds: "They weren't assuming I was dodgy, or angry with me, you know. For some reason that was a huge boost to me. It was the first time in a long time I didn't have to have a barrier up to the world."
Now near the end of her two-year course at SAOL, Keoghan has completed courses in computers and literature and hopes to get "even a cleaning job" at the end of it.
"I have my self-respect. It's like I'm after waking up from a coma," she says.
THE SAOL PROJECT is widely regarded as a huge success. Since it began eight years ago 86 women have attended its courses. All are from the local area. Some have gone on to jobs, some to evening courses, and others to Trinity College Dublin and UCD. The project offers education, employment and counselling support to women at a critical transition point.
Held up as a jewel in the Government's National Drugs Strategy crown, SAOL is, however, struggling to survive.
"We're facing into 2005 with a shortfall of €50,000 next year," says director Joan Byrne. "We lost two key staff this year due to cuts. If we don't make that up we are going to lose the one-to-one counselling. And if we lose that, what are we doing at all? It's key to what we do with the women."
Anna Quigley, of the Citywide Drugs Crisis Campaign, says SAOL's difficulties are symptomatic of wider problems the community sector has with the National Drugs Strategy. Introduced by then minister of State, Eoin Ryan TD, in May 2001, the strategy is currently undergoing a mid-term review. At its inception, the strategy was described by observers as "the most far-reaching and radical attempt ever taken in this State to tackle drug abuse".
Heroin had been devastating communities in Dublin for a decade. This reporter recalls writing of four deaths as a result of heroin in the space of a fortnight, in a pocket of streets around Amiens Street in July 1996. The anger and frustration of communities burying their young exploded on to the streets with nightly marches. The issue of drugs created a national emergency. By the time the strategy was launched, Quigley says, "We saw the recommendations of the Ministerial Task Force on Drugs being implemented without delay. Budgets were put in place to facilitate prompt delivery of plans. The political will was there". Now, she says, the overall impression is that communities are tired and disillusioned.
Based on four ideas - drug supply reduction, prevention, treatment and research - the strategy promised that 100 individual actions would be taken before 2007. An inter-departmental group on drugs at Government level was established. Last year 10 Regional Drugs Task Forces (RDTFs) were established in addition to the 14 local drugs task forces. A National Drugs Strategy Team co-ordinates all of these.
But community groups believe the strategy has ground to a halt. There are complaints that the community sector - which was to be to the fore - has been sidelined; that task force co-ordinators are not independent of health boards, as had been promised: that funding is being cut in many areas; that there has been no progress on many individual actions; and that the strategy is too rigid, unable to respond to evolving issues such as the escalating cocaine problem and the emergence of multi-drug abuse.
Tony Geoghegan, director of Merchants Quay - the largest voluntary drug treatment centre in the State, echoes many when describing "a sense of loss of focus, a loss of urgency".
There is a perception that the drugs issue was demoted on the Government agenda in 2002. Until then, Eoin Ryan was a minister of State solely in charge of the National Drugs Strategy and reporting directly to Cabinet; his successor, Noel Ahern, however, was appointed to take on housing as well and reports now on drugs to the Oireachtas sub-committee on social inclusion.
"This change was seen by communities as a clear signal of the declining importance of the drugs issue to Government," says Geoghegan.
Ahern rejects this, insisting that the drugs issue is taken "as seriously as ever".
Geoghegan says that while there has been "loads of action on providing methadone treatment" - the numbers on treatment have doubled to more than 7,000 over the past three years - there has been little or none of the promised action on increasing ancillary services such as follow-up counselling and vocational training. It is nearly impossible now to get on a detox programme, he says. Methadone maintenance is almost the only treatment option, and it doesn't help addicts who wish to become drug-free.
He points out that the availability of needle exchanges is very limited. There is a lack of effective treatment for cocaine addiction and the strategy "does not seem to have had any considerable impact on the supply of drugs", he says.
COMMUNITY WORKERS OUTSIDE Dublin believe the strategy has failed to prevent heroin moving beyond the capital. Figures published by the Drugs Misuse Research Division of the Health Research Board in September show that the number of people in treatment for heroin abuse outside Dublin has quadrupled from an average of 6.6 per 100,000 of the population in 1998 to 25.4 in 2002. Ahern claims this is "a success", as the strategy has been about getting people into treatment.
Martin Hayes, a Tipperary community representative on the South-East RDTF, says there is widespread goodwill towards the strategy, "But there are things that aren't happening that were promised". There has been no support for developing community representation or for advising groups on how to access funding, he says.
"There is also a sense that a lot of the driving force has fallen into the hands of the health board," he says. While RDTF co-ordinators were to be independent and health board employees were appointed as an interim measure, there appears to be no attempt to move forward on this.
Also, although a small amount of funding was granted to set up the RDTFs last year, no more has been forthcoming. These issues, combined with bureaucracy, make the process off-putting, says Hayes. Outside Dublin the main drug of concern is still alcohol, he adds, reckoning the National Alcohol Strategy should be linked to the drug strategy.
Ahern says he is aware of all the issues raised and that they will be addressed in the review. "They are all in the mix. That is what the review is for," he says. It will report early in 2005, he adds.
Keoghan is certain that without SAOL, she would be dead today. "Even though I was clean when I came here, I still didn't know anything, only drugs. I was heading for a box. There should be places like this all over the country. They've taught me how much I just can't afford to fall again. I'm going to be a granny next April. I've a lot of being a mammy to do."