The Harm Done: Community and Drugs in Dublin is a memoir by Dr Barry Cullen that is grounded in his career since the early 1980s in community work, social services (as a qualified social worker), and as a lecturer and researcher in third-level settings.1 In his introduction, Cullen says that this ‘personal narrative’ (p. 15) is aimed at those whose lives have been impacted by drugs and those who study, work, and write about drug issues, community work, and related policy areas. The book culminates in a call for major reforms to Ireland’s drug policies and for community development as an essential element of the country’s response to the drugs issue.
Community development
Underpinning the narrative of the book is Cullen’s commitment to community development ‘particularly in helping groups and communities to celebrate shared identities and to find solutions to social problems’ (p. 16).1 Based on his experiences in the field, he illustrates the strength and capacity of community groups to address the problems associated with drug use. He grew up in the Dublin suburb of Ballyfermot with parents involved in community work. From an early age he learnt of its value and the barriers faced by people active in this field. His training as a social worker took place in an era where community development and the field of social work were changing rapidly. The context was evolving from one in which the Catholic Church and its religious orders had dominated to one in which lay people were becoming increasingly involved. Furthermore, the individualistic approach of social work that focused on the individual’s behaviour in isolation as the problem that had to change was being challenged. A broader understanding of how a person’s environment and the systems within it impact on their experiences and outcomes was being taught.
Heroin use as an issue
When he qualified as a social worker in 1980, Cullen took up a role as a community social worker in St Teresa’s Gardens (STG) in Dublin’s south inner city. Heroin had become more widely available in the area and criminal gangs were involved in its importation and distribution. The impact of this was seen at the local level with an increasing number of young people injecting heroin. Cullen witnessed the escalating drug problem in STG and other parts of the city. He describes the ‘catastrophic failure’ (p. 48) of the Department of Health to listen to people working in the community who warned about the escalation of heroin use in the late 1970s and early 1980s. There was no formal mechanism in place to have these voices heard. He describes a systematic failure of the Government and State bodies throughout the 1980s to act, despite numerous calls to do so by local stakeholders. Cullen concludes that ‘the extent of institutional denial was deeper than anything previously suspected’ (p. 58).
Abstinence model for managing drug problems
In the 1970s and 1980s, and leading on from the ethos of alcohol treatment, the treatment for heroin use was dominated by the abstinence model to the exclusion of all others. While both alcohol and drug use were treated medically under a disease perspective, Cullen witnessed a distinct difference in the attitudes of service providers towards those seeking help – those who used drugs other than alcohol tended to be treated with a much more punitive approach. He argues that the National Drug Advisory and Treatment Centre and Coolmine, who both worked to an abstinence model, dominated the statutory treatment response to heroin at the start and did so for almost two decades. This occurred, despite no rigorous evidence base for a positive impact of their services. Cullen argues that the abstinence model continues to be represented as the ideal for treatment in Ireland today.
The communities respond
Chapter 5 describes how in the absence of an adequate State response, communities in the early 1980s began to organise themselves to address the issues they faced as a result of drug use and its trade. Their main concerns included the harms caused to individual residents who were using and their families, the extensive intimidation being experienced by residents from those involved in the trade, and the damage to the reputation of their communities. Cullen provides an in-depth account of how members of the STG community held meetings in the early 1980s, which evolved to form the STG Concerned Parents Against Drugs (CPAD) group. He describes the meetings that took place, how they identified actions and initiatives to help address the issues faced, and how they started to take action. At the time, STG was a ‘well-established central point of supply for most of South Dublin’ (p. 75).1 Among the first activities organised by the STG group was residents blocking access to the estate for those coming in to buy drugs. This resulted in a shortage of supply for users across the south inner-city area, which was seen to demonstrate the need and value of their local community-driven response. The focus of many of the activities was on discouraging dealers from selling drugs in their community.
Cullen’s descriptions of efforts to keep boundaries on the meetings and activities of the local groups, as well as the threat to their safety from those involved in the trade, illustrate the challenges faced in community work. Tensions arose within the community on the best approach to be taken to address the issues arising. For example, some of the activities of a broader CPAD group (the eviction of dealers from their homes) caused division within the community. However, as Cullen sees it the core argument remained, which was that the State had not done enough to address the escalating problem, so the community had to take direct action.
A failed youth project
Between 1983 and 1985, Cullen was the project leader for the STG Youth Development Programme. The project that would work in prevention and treatment was welcomed by the community, but he experienced barriers to delivering on what the community needed. There are two recurring themes in this chapter that illustrate the challenging environment in which he was working. First, the Health Board (and its funding) remained wedded to the abstinence approach to treatment. Cullen was a strong advocate of services that would offer an alternative to abstinence for people who used drugs, but could not secure funding for this. Second, there was a lack of support for a community grassroots-up response to the drugs problem, which was indicated by the concentration of users from a small number of communities. While the link between drug use and these areas was documented, it was not widely acknowledged or discussed by service providers and policymakers: the Government ‘favoured retention of the centralised system and squashed the community model before it could even get properly started’ (p. 87).1
Community and political conflict
The chapter titled Community and Political Conflict deals with the complex relationships between the community and political entities. Direct action by communities against dealers between 1983 and 1985 was seen as largely successful in terms of removing dealers from some communities. However, politicians and authorities, especially the Health Board, were seen by Cullen to be stifling rather than supporting community activities. Furthermore, he recognised that the main political parties by and large were neglectful of the community initiatives. This was in part attributed to a perception that Sinn Féin and the IRA were supporting the ‘anti-drugs’ campaign. Cullen describes the complex nature of these relationships and the impacts on communities and their activities around responding to drug use and its trade. Media coverage was suggesting that ‘anti-drugs community groups were superficially dealing with the problem and being manipulated’ (p. 100).1 This undermined the value of the work of community groups and what they had achieved. While there were elements of manipulation by Sinn Féin and the IRA of the broader ‘anti-drugs’ movement in the city at the time, Cullen rejects the suggestion that they were in control of the community’s activities in STG. Cullen argues that the community movement should have been supported by institutions to develop an appropriate infrastructure. Where this was lacking, it left groups vulnerable to others taking advantage for political or other purposes.
Community model for managing drug problems
Cullen joined the Ana Liffey Drug Project (ALDP) as director in 1989, at a time when HIV and AIDS were prevalent among injecting drug users in Ireland. He describes the 1990s as an era of great change, in which services beyond those driven by abstinence became more widely available and the role of the community model was formally recognised. ALDP supported people not only with their drug use but also to resolve other personal, social, and family issues. The wider infrastructure required to work in this way was not in place at the time, but ALDP used individual cases to try and change the system.
The community model gained traction in the 1990s with the establishment of initiatives across the city and has been part of Ireland’s national drugs strategies ever since. The First Report of the Ministerial Task Force on Measures to Reduce the Demand for Drugs (better known as the Rabbitte Report) was published in 1996 and recognised the link between drug use and economic and social deprivation, recommending the establishment of what would become the Local Drug and Alcohol Task Forces in the areas most affected.2 This constituted a major shift in Government policy, in part because it was accompanied by significant funding for the first time. Cullen argues that this approach was not new and that many elements had been outlined previously in 1983 in an unpublished Government report by the Special Government Task Force on Drug Abuse: ‘The overall effort aimed to help deal, in a focused manner, with the close association between heroin use and socio-economic disadvantage, an approach so patently avoided and institutionally undermined in earlier decades’ (p. 120).1
Not all plain sailing for task forces
Overall, Cullen highlights the value of the community model in addressing drug issues. He draws on his experience as coordinator of the Dún Laoghaire Rathdown Drug and Alcohol Task Force (2013–2021) to illustrate the array of activities and successes delivered through this community model. However, he also highlights the negative impact of the financial cutbacks experienced by task forces since 2008. The development of rehabilitation (as opposed to treatment) interventions has been particularly impacted by this lack of resources. The lack of adequate funding means that task forces are at risk of stagnation and cannot respond properly to existing and emerging trends. He sees the current national drugs strategy as placing responsibility for drug policy back in the Department of Health rather than at the community level.3 He is heavily critical of the current structures, including Sláintecare, which he argues fails to take account of the uneven distribution of the drug problem in localities:
The new model appears as a return to doing business as previously during the 1980s, when the central structure was ascendant, and when the attitude of the health authorities, as the heroin problem emerged in inner city communities, was that they could not act until they had a single, universal plan for the whole country or region. (p. 129)1
He recognises that the task force model needs renewal, but argues it is essential that a local partnership approach is adopted so that people have access to wraparound services.
Changing the unchangeable drug laws
Cullen argues for a major change in Ireland’s drug laws, for a policy move that would legalise and regulate all drugs. A recurring theme in this chapter is the hypocrisy of how Ireland deals with alcohol when compared with other drugs, given the extensive harms it can cause. He supports an approach that acknowledges that people use drugs (legal and illegal) to get intoxicated and looks for a system in which that can be facilitated, while minimising the harms caused. As the situation currently stands, prohibition causes problems of violence, drug debt, and intimidation. For those living in communities affected by drug use, there is not necessarily a need for more treatment, rather ways to deal with ‘the everyday fear and violence caused by drug criminality and its pervasive impact on young people’s lives’ (p. 136).1 He advocates for a position in which Ireland would make a large rather than a gradual move to legalisation and regulation. The market would be under the control of the State. In contrast, a gradual approach would create an environment in which the drug industry would have time to develop a powerful position to influence policy – akin to what is currently the case with the alcohol industry.
Reimagining and strengthening community
In his final chapter, Cullen reiterates the importance and power of community work and how it can bring about small yet significant changes in everyday lives. Throughout his career he has seen the positive impact of community development and associated organisations or initiatives, and how these have been severely negatively impacted by the economic recession and various Government policies. He argues for community development to be more reliably funded, with proper structures to develop and support their work.
Concluding comment
Cullen’s book provides a valuable overview from his perspective of the history of heroin use in the south inner city of Dublin and the community’s response to the problems it has caused. His narrative reflects the frustration of working in an environment where the only formally accepted and funded approach to meeting the needs of people who use drugs (i.e. abstinence) was failing and the voices of those working in the communities calling for change were largely ignored. This, inevitably, resulted in more harms and loss of life. It was coupled with a political context, in which the concentration of drug use in areas experiencing economic and social deprivation was not acknowledged, despite the availability of data proving this link. Cullen illustrates not only the value of the community model in addressing these problems but also the barriers faced by communities in trying to do this work. His decades of experience have led him to the conclusion that the criminalisation of drugs and their users is adding to the problems and that Ireland needs to take a radical approach to drug laws, introducing legalisation and regulation.
1 Cullen B (2023) The Harm Done: Community and Drugs in Dublin. Dublin: SethBrimmers.
2 Ministerial Task Force on Measures to Reduce the Demand for Drugs (1996) First Report of the Ministerial Task Force on Measures to Reduce the Demand for Drugs. Dublin: Stationery Office. Available from:
https://www.drugsandalcohol.ie/5058/
3 Department of Health (2017) Reducing Harm, Supporting Recovery: a health-led response to drug and alcohol use in Ireland 2017–2025. Dublin: Department of Health. Available from:
https://www.drugsandalcohol.ie/27603/¬
