Vendula Brtnikova Loo

In February 2019, I went to an internship in Dublin, to the largest addiction treatment organization in Ireland - Coolmine. During the 5 days I had the opportunity to spend in the organization, I visited the whole spectrum of services from low-threshold, out-patient, to residential care. 

I spent Monday in the men's therapeutic community, which is the only public community in Ireland. Due to its history, it is based largely on the principles of Alcoholics Anonymous and the program in the community is very structured and regime-based. The only therapeutic work done in the community is group therapy and all other sessions are based on counselling without going deeper into different issues surrounding an addicted person. Psychotherapy happens outside of community in private sessions, upon a wish by each individual client.  

A big surprise for me was that in Coolmine trained therapists work very sporadically, most of the workers are former clients who have undergone treatment themselves. This principle is a certain advantage of this organization, at the same time a drawback that forces clients to seek individual therapeutic sessions outside the community environment, which they are often forced to pay beyond the treatment. 

The next day I was in a therapeutic community for women and mothers with children. A program that allows dependent mothers to enter treatment even though they need to care for a small child is very supportive and educational. Overall, workers in this community were very positive, perhaps because of the number of babies they took care of daily, while mothers attended a therapeutic program. It was very beneficial for me to see withdrawal conditions in infants, which allowed me to combine findings from clinical addictology from another perspective. I spent most of the days just hanging out with these babies, simply because I wasn't allowed to participate in other programs. But talking to the staff which takes care of these children was quite an interesting experience.

Undoubtedly the most interesting day was Wednesday, when I went to the youngest service of the Coolmine organization, an addictological adolescent clinic. The treatment, which was opened by the organization only in November 2018, is still in its infancy and the workers themselves are in the phase of the program and self-development to work with the juveniles. The program focuses on two client groups - marijuana users and alcohol users. This service was naturally very interesting to me, because I work in a similar outpatient office in the Czech republic, where we deal with children and youth under 21 years old. The big difference from our ADA + service is that the programs work with motivated clients who have decided to treat themselves or are forced to abstain due to circumstances. Cooperation with the family is not a condition in this program, only in case of interest the workers are willing to invite family members to the treatment. The treatment set up by the staff is highly structured and involves the use of worksheets and therapeutic techniques throughout the group. Workers guide clients through the activities, help them answer questions and complete exercises. It seemed to me that the worker was more of a coach than a therapist. This approach gives space in such a structured program because the treatment is not focused on in-depth problem solving, on the contrary it is more systematic and clients are encouraged to participate in therapeutic activities outside the program beyond this treatment and attend support groups of Alcoholics Anonymous. I left this internship with a number of copied activities, but with the assurance that we are constantly adapting the program in Kladno to the individual needs of our clients and the problems they are facing. We work with a much wider range of clients than in Dublin, and I feel more free in this approach. 

I spent the last two days in low-threshold services and a day care center. I have never experienced active users being able to attend a regular, all-day, structured program. The service building is located in the center, in the open drug scene, and offers common cooking, cleaning and group activities during the day. Once clients are sufficiently stabilized on methadone, and with clean tests, they can move further into a motivation program that gradually directs users to treatment in the therapeutic community. The services in the organization are very interconnected and the care of clients is complex, as much as possible. What else interested me in the internship was the technical side of the services. The organization used an electronic database in which workers could share client information, calendar, communicate with each other, and the database was very flexible and user-friendly. Overall, I would consider the internship a very beneficial experience, which I would recommend to all workers who would like to inspire and spice up their work with new ideas and experiences!