New dual diagnosis programme will help those ‘entrenched’ in crack cocaine addiction 

crack cocaine
Some of the 24 crack cocaine users who spoke openly about their experience to researchers noted a "lack of understanding" on dual diagnosis.

The pilot programme, commencing later this year, will provide much-needed combined care in the Mid-West as a recent report highlights the ‘adverse effects’ of crack cocaine on users’ mental health 

By Rachel Petticrew 

A LONG-AWAITED pilot programme to treat those battling drug addiction and mental health illnesses will finally be rolled out this autumn – more than a year after it was first announced Limerick Voice can reveal. 

The need for a dual diagnosis programme was indicated by research 15 years ago and the HSE has identified a clear need for the service since 2007. 

The confirmation of plans to finally pilot the new programme in Limerick and the Mid-West follows the publication of a major new study, which highlighted the widespread availability and accessibility of crack cocaine in Limerick. 

The study, carried out by researchers in the University of Limerick and commissioned by Ana Liffey Drug Project revealed the dangers and realities of crack cocaine use in Limerick city, including the ‘adverse impact’ it has on ‘the mental health of its users’. 

“Outside of Dublin, you tend to see less well-resourced drug addiction services.”

Several local services currently offer inter-dependent dual diagnosis treatment to some degree, but until now, there has been no formal treatment programme. 

“What we see is that a lot of these services are trialled in Dublin and maybe Cork, and then eventually make their way to Limerick,” explained Dr Dervla Kelly, co-author of the new study: Doing More: The Health and Social Impacts of Crack Cocaine Use in Limerick City, published last month. 

She added: “There’s a bit of a delay there that is a little bit hard to understand or justify really. Outside of Dublin, you tend to see less well-resourced drug addiction services.”

Some of the 24 crack cocaine users who spoke openly about their experience to researchers noted a “lack of understanding” on dual diagnosis, feeling as though they were “falling between two stools” in terms of treatment. 

According to Dr Kelly, the exponential growth of crack cocaine in Limerick city first became obvious to outreach teams in 2019. Possible reasons for the drug’s popularity include its smokable nature and widespread availability, particularly in disadvantaged areas. 

Michael Lacey, Chair of the Mid-West Regional Drugs and Alcohol Forum (MWRDAF), emphasised that those using crack cocaine are often “individuals with complex issues”. 

“If you have someone who has schizophrenia and is using cocaine, that has a huge impact on them,” he told Limerick Voice. 

According to a HSE spokesperson the difficulty in recruiting specialist staff has delayed the introduction of the new Dual Diagnosis programme in Limerick, which was due to be up and running by the end of last year. 

The HSE Midwest has also said that recruiting staff in the current climate is extremely difficult for all mental health services, both in Ireland and internationally. 

The spokesperson told Limerick Voice that 13 posts would need to be filled to operate the Dual Diagnosis programme, with five new staff due to take up positions “in the coming weeks”. 

The recruitment for the remaining positions is necessary for the programme to commence on time, he added. 


Crack cocaine users often “become addicted to it very quickly, and become entrenched in that addiction very quickly,” according to a project manager of a local detox programme.  

As the use of the drug becomes more prevalent in the city, new health complications are also coming to light.  

“With crack cocaine becoming such an issue in the city, there are lots of health complications that people are now having that we haven’t seen before,” explained Julie McKenna of Novas’ Midwest Community Detox programme. 

“People are becoming really, really, unwell really, really quickly.” 

Ms McKenna emphasised the importance of early intervention in ensuring positive outcomes and solutions. 

“It’s only by getting the lived experience of the [outreach] worker and the client that you can actually look at what interventions the city needs. The earlier we have interventions, the better chance we have of positive outcomes and solutions,” she added. 

Emphasising the dangers of crack cocaine specifically, Michael Lacey of the Mid-West Regional Drugs and Alcohol Forum (MWRDAF) said: “If the area of the nose was about a square metre… the area of the lungs is the size of a tennis court. Because of the size of the lungs, you can keep on smoking until it kills you, or completely destroys you.” 

While statistics included in the Ana Liffey research show a sharp increase in cocaine use, this increase may be worse than reported as crack cocaine users do not always come forward for treatment. 

Heroin users in Limerick have access to the substitute methadone, as well as naloxone (which reverses the effect of an overdose), however, no comparable medications exist for crack cocaine users, making them less likely to present to addiction services. 

“There is no substitute for cocaine; it’s more psychological,” Mr Lacey explained. “It does awful damage to the whole system, neurologically and physiologically.” 

“If the area of the nose was about a square metre… the area of the lungs is the size of a tennis court. Because of the size of the lungs, you can keep on smoking until it kills you, or completely destroys you.” 

He also noted that users who enter any treatment programmes are dependent on community support in order to be successfully rehabilitated. 

“The thing is, even when you get someone in for treatment and they stabilise, when they come out… there’s no place for them. They may have to go back to an area that is problematic and lacking social amenities. 

“If a young lad is living in an environment where he can buy crack next door, the chances of him stabilising are low.” 

As one user told researchers of the Ana Liffey report, “I only have to knock in next door and like, I can have it. I can smell it in the air when I walk around. That smell alone would drive you back… You go running for it.” 

crack cocaine

In addition to the recently announced Programme for Dual Diagnosis, a new Law Engagement and Assisted Recovery (or LEAR) programme will see Ana Liffey Drug Project’s Midwest team work side-by-side with An Garda Síochána to support crack cocaine users and offer harm reduction and treatment programmes from next month. 

“Having a small amount of drugs for personal use, that conviction is going to do them no good whatsoever,” said Dr Kelly. 

“It’s about giving the guards an option to find a suitable way to engage with people other than prosecution, because that’s been their only option until now.” 

“People who get serious addictions to these types of drugs generally are using them to cope with some sort of trauma. That’s the bottom line,” she continued. “If you or I had been through something similar to what these people had experienced, chances are that we’d be using drugs to cope with it as well.” 

Find out more about Ana Liffey Drug Project Midwest.

More stories from our 2023 print edition

Explainer: Ana Liffey and An Garda Síochána’s new LEAR Programme   

Funded by the HSE, the €200,000 LEAR project will provide a ‘co-case management’ programme to reduce harm caused by crack cocaine in Limerick. The unprecedented link between local services will help to engage vulnerable users in accessing treatment programmes. The project is due to be rolled out next month.   

“With the person’s consent, my team on the ground will make referrals to Ana Liffey’s LEAR team for people who fit the criteria as needing case management supports.” – Derek Smart, Chief Superintendent of the Limerick Garda Division.   

“The LEAR approach has been in place in Dublin since 2014 and I hope that its adoption in Limerick, specifically in relation to crack cocaine, will help those who are seeking to take a different path and escape the clutches of crack cocaine.” – Maurice Quinlivan, Sinn Féin TD, Limerick City. 

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