Problematic Alcohol Use and Traveller men. Marie Claire Van Hout M.Sc Addiction Studies M.Sc Health Promotion

The Travellers The Traveller Community'' have been identified “as people with a shared history, culture and traditions including, historically, a nomadic way of life on the island of Ireland” (Joyce, 2002:9). The number of Travellers in Ireland has increased somewhat over the last three decades, but they remain a minority proportion of the total population (0.6%) (Census, 2006).

The Traveller Community The Traveller community are particularly vulnerable to problematic alcohol use often exacerbated by experiences of discrimination, marginalisation, social exclusion, poor educational attainment, inadequate housing, compromised health and poverty (Fountain, 2006). The Traveller culture once offered some resilience to drug and alcohol misuse, in terms of strong family networks and anti drug attitudes (Joyce, 2006). Increasing levels of alcohol abuse and problematic drug use among Travellers is reported, and occurs in conjunction with the merging of Traveller communities with “settled” or mainstream communities.

Travellers and Sustance Use There is a dearth of national and regional information regarding the Travellers and their levels of alcohol and drug use, due to the lack of ethnic identifiers in health reporting systems and difficulties in engaging with Traveller communities. Localised surveys indicate that male Travellers exhibit higher levels of both alcohol and drug use, than Traveller females, and that the Traveller community report lower levels of drug use than the general population (NACD, 2007).

Research Design The research was part of a large scale funded regional needs analysis on Travellers and substance use in the west of Ireland (Western Regional Drugs Task Force, 2009). The research was qualitative and involved 4 focus groups with Traveller men (n=19) in the west of Ireland. A predevelopment research phase of several months was conducted in order to build trust and commitment among the Traveller halting sites in the west.

Research Design A peer accompanied approach was conducted whereby a Traveller male recruited and facilitated the focus group, in order to garner trust and cooperation with the researcher. The focus groups explored themes relating to Traveller culture and alcohol use, prevalence and patterns of use, attitudes to alcohol, awareness of alcohol related harm, current patterns of alcohol use, motives for use, perceptions of risk, experiences of addiction services and primary healthcare programmes..

Data Analysis A thematic analysis using Nvivo explored the information gained within the context of illustrative conversation segments and discussed areas of similar and contrasting opinions. The analysis is strongly grounded in the research information garnered.

The Traveller Perspective Traveller culture is traditionally very religious and religious celebrations (weddings, funerals) are often the context for heavy drinking and drug use. Whilst the Traveller men recognised the negative impact of alcohol abuse on themselves, and their families, they found that due to high levels of boredom, depression and stress, they were unable to curb their alcohol use. Some Travellers suggested that while they are aware of Travellers who may have a ‘drink problem’, others would be ashamed to admit that they have a problem with alcohol.

The Traveller Perspective Almost 100% of Travellers accessing treatment services in the region were reported to be male, presenting with alcohol dependency, only attending once or twice and usually in the advent of a court case. Alcohol dependency is commonly dealt with inside the Traveller community, using religion (prayers) and home detoxification without medical supervision. Residential and group counselling programmes are difficult for Traveller men to engage with, in terms of their difficulties to integrate with members of the settled community.

The Traveller Perspective Addiction and counselling services are also deemed lacking in culturally appropriate information, cultural sensitivity and cultural acceptance from health professionals. It appears that Traveller culture is dissipating as this ethnic group assimilates within the “settled” community and this fragmentation has contributed to compromised resilience against problematic alcohol and illicit drug use.

Potential Interventions Potential alcohol dependency interventions offering most promise, include brief interventions of 4-6 weeks used to engage with and up skill the Traveller men with alcohol education and counseling skills, and this was deemed to contribute to improved peer led education and support within the male Traveller community, and improved pathways to accessing health and community services. "Travellers listen best to a Traveller"

Conclusion Preventative and treatment efforts for problematic alcohol use in Travellers must incorporate a gender specific Traveller led approach, as Travellers remain an excluded group in Irish society. Services must take into consideration the needs of Travellers in terms of their life experiences, their culture, illiteracy, feelings of discrimination and difficulties engaging with treatment modalities. “Travellers and settled people working together... Has to come from everyone.” “Travellers accessing services need to be reassured there is an understanding of their culture and an acceptance of it.”