Tipperary based Aiséirí is setting the gold standard for addiction treatment

A decision taken by a Tipperary nun forty years ago set in train a movement that has now become the gold standard for addiction treatment and recovery in the country.
Sr Eileen Fahey’s foresight in establishing a new and innovative way to treat alcohol addiction at her pioneering centre, Aiséirí in Cahir, has helped thousands of people towards recovery in the four decades that have followed.
Treatment in the early years at Aiséirí was primarily for those with alcohol addiction but expanded over the years to include drug addiction and gambling in its care programme.

RESURRECTION
It has also expanded from its initial home at Townspark, on the outskirts of Cahir, to three additional centres in Wexford, Kilkenny and Waterford, each dealing with different aspects of the care and recovery programme. Aiséirí is the Irish for resurrection and that reflects the philosophy of the service.

The inadequacy of a revolving door system for people suffering from alcohol addiction was what spurred Bansha-born nun Sr Eileen into action. As a nurse at the former St Michael’s unit, on the grounds of South Tipperary General Hospital, she saw patients being detoxed and discharged without any follow-up treatment.
Relapsing was a common feature for the patients and very soon they were back in St Michael’s. Sr Eileen’s research into a more progressive form of treatment took her to the United States and she returned with the world-renowned Minnesota Model of residential care and follow-up treatment which she established in a former family home in Cahir, acquired by her order, the Sisters of Mercy.

RECOVERY SUPPORT
Head of Recovery Support Services at Aiséirí, Gerry Carroll, says that approach has been developed and expanded over the past forty years.
“This is the model we use. We are constantly reviewing our responses to emerging needs, almost to the degree that we are ahead of them because we are working at the front line and know the presenting issues. We are solution-focussed, deciding what will work better and what will help people stay in long-term recovery. That is our goal,” he said.

Those emerging needs have seen Aiséirí expand throughout the south east. Cahir was opened as a residential treatment centre for adults with the 28-day treatment programme in 1983; a second residential centre opened in Wexford in 1988; the Aislinn centre in Ballyragget, Co. Kilkenny was established in 1998 as the country’s first adolescent residential treatment centre for those aged 15 to 21; and the fourth centre, Céim Eile opened in Waterford city in 2002 to provide continuing care for clients at the conclusion of the residential treatment.
When Aiséirí first opened in Cahir, about 80% of its treatment was for alcohol addiction. Forty years later the figure of alcohol addiction has dropped to 40%, with 40% also for drug addiction and 20% for gambling.

FOUR DECADES
Those figures reflect changes in society over the four decades but Head of Clinical Services, Sara Cassidy, points out that the treatment for all three is the same. “Addiction is addiction”, she says.
“It doesn’t make a difference what chemical you are dealing with as the consequences are the same and the Minnesota 10-Step programme is effective for all addictions. Whether it’s drink, drugs gambling, we look at every area, starting with where a person is coming from, what they have been through, what support they may need and then work an individualised care plan around that.
“And we work with the families as well as that’s one of the biggest things going forward. The families are in huge distress, really distraught and don’t know where to turn, what to do or how to cope. Family members can become terribly unwell themselves, they can’t sleep, can’t eat, it affects their mental health and they need support too.”
Key leaders of the Aiséirí management team, Sara Cassidy and Gerry Carroll, don’t sugarcoat how people are when they arrive at any of the centres.

COMPLETELY BROKEN
Mr Carroll says – “We see people at their lowest, they are on their knees, completely broken. You don’t come in for treatment for the craic, it’s a last resort when everything is gone. When people arrive here, it’s chronic. It may not look like that from the outside as people put on masks to hide it. But their addiction impacts marriage, mental health, finances, employment. People only come when it’s a crisis, when it is nearly all gone”.
Sara Cassidy adds that people arriving at the front door of the Cahir centre are very often ‘in the gutter’, especially where alcohol or drugs are involved. Most centres won’t accept people for treatment unless they are clean and clear of the substance involved.

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“In Cahir we are different. Some people just couldn’t stop their addiction and start their 28-day abstinence-based treatment. In Cahir we opened a detox unit so that people could be safely detoxed, with a lot of support, and then start the 28-day programme. That’s our core model. In the adolescent unit it is even longer, a 42-day programme plus detox,” she said.
Gerry Carroll describes addiction as having a ripple effect but stresses so too does recovery.
“We are focussed on a positive ripple into recovery,” he says.

Sara Cassidy outlines what that recovery looks like – “It’s incredible to see the moods and shifts throughout those 28 days. It’s amazing to watch and every minute is needed. To see the changes is unbelievable. People come in for treatment, nearly half dead, through alcohol, drugs or gambling. They are on their knees and to see them leave 28 days later is incredible. Their faces are bright again, they have a smile, it’s a new life for them.”
And she stresses that they are not forgotten once they walk out the front door. “After the 28-day residential programme, we have a recovery support programme for two years, one night a week, and every month they continue to engage with us. So, it’s really a two year and 28-day programme”.

She describes addiction as a ‘mad illness’ as it’s the only illness that tells suffers that they don’t have it, and they in return ask everyone to leave them alone and say that they’ll be fine. “Addiction is riddled in denial. People say that I don’t need this, and I don’t need that, and if they drop away from continuing support then the recovery rate will drop. For those who follow the plan to the letter, there is a 98% recovery rate. And in Aiséirí the recovery rate is above the international average”.
Aiséirí has a staff of 120 across its four centres with an additional 100 volunteers nationwide. They help the 500 people engaged in recovery support throughout the country, broken down into 32 groups.
“If we have a cohort of people in recovery we will set up a group to support them”, says Gerry Carroll. “We are always responsive to needs and trends. The longer approach we take to recovery tends to attract people. And we have taken a lot of the obstacles out of the way for people to come for treatment, especially with the provision of detox, as other centres don’t provide that”.

Covid lockdown proved to be a particularly busy time for the service, especially in Cahir, which was the only residential treatment centre of its type to remain open during the pandemic, and which saw its capacity grow from a 12-bed unit to 22-bed.

COVID
Sara Cassidy says that addiction rocketed during Covid. “Some people may have been predisposed to addiction already, having wine at night, but working Monday to Friday in the office kept them stable. But working from home, the alcoholism grew and accelerated and they needed treatment more quickly, although it may have done so anyway,” she said.
As it looks forward to the future,last September, Aiséirí published a four-year strategic plan, ‘One Step at a Time, 2024-2028’, on the 40th anniversary of the day the doors first opened at the Cahir centre. The plan sets out the ambitions to further develop the capability and expertise built over the past forty years through five strategic priorities, one of which is funding.

FUNDING
And the key part of funding that is so crucial is the provision of secondary treatment, once the residential treatment ends. Gerry Carroll stresses that the HSE and the Probation Service have a key role to play here, but are not doing so.
It costs between €8,000 to €9,000 for the 28-day residential treatment service in Cahir. That is either funded by private health insurance, people who pay their own fees, or funding from the HSE or the Probation Service – the Probation Service involvement is for those who have gone through the criminal judicial system.
Sara Cassidy explains that where the HSE have paid for the residential treatment, they may have already funded up to three other treatments for the same individual, bringing the cost up to nearly €50,000.

“But we cannot get them to grasp the cost-saving of secondary treatment. We have tried everything and they will not look at it. The long-term treatment is half the cost, has longevity and the outcome is great. It defies logic that they won’t open their minds to it,” she said.

ENTRENCHED
Gerry Carroll says the same applies to the Probation Service. “We have people who have come to us a number of times, and have had other treatments before they get to us, paid for by the Probation Service. Some might have served jail sentences but the Probation Service won’t pay for the long-term approach. It is not expensive, in fact it is much more reasonable. The United States are about twenty years ahead of us on this. It was discovered that the 28-day programme worked for some, but not others with deeply entrenched addictions, who needed the secondary care.

“Government strategy accepts that long-term works but they haven’t put the money behind it yet. We are providing a really essential services for the HSE and the Probation Service. When their clients engage with us, they have the opportunity to get really well. They need us as much as we need them. We just want to help people who desperately need help,” he said.
And that remains the goal for the future, as it has been for forty years, since Sr Eileen took that momentous first step.
“Those who come to us are in so much pain and we want to make it easier for them and relieve that pain,” says Sara Cassidy.
“It is great to see people with their peace of mind back, finding their voice, with their lives back together again, after being completely demoralised by their addiction. They can take pride in themselves again, and say – I was very unwell from this addiction for a period of time but here I am now,” she said.