A Visit to Dr. Till Kinkel’s Praxiskombinat Neubau: A Model Clinic for Comprehensive Substance Use Care and Support

On June 26, 2024, I had the distinct privilege of visiting Dr. Till Kinkel’s medical office at Praxiskombinat Neubau. As one of the two founders, Dr. Kinkel has created a space where professionalism and genuine care are the core of the clinic's philosophy.

The Birth of Praxiskombinat Neubau

Established in April 2020, Praxiskombinat Neubau was conceived as a pioneering model program in Germany, addressing a critical need for comprehensive care among people who use drugs. The clinic's founding principles are centered around:

• Ensuring Survival: Creating a safe and supportive environment for individuals who use drugs.

• Care and Compassion: Offering compassionate care to improve the quality of life for patients.

• Risk Reduction: Mitigating health risks and reducing risky behaviors associated with drug use.

Overview of Services and Clients

Praxiskombinat Neubau provides extensive treatment options for individuals with opioid addiction, including those dependent on heroin, fentanyl, tilidine, and other opioids. The clinic adopts a personalized approach, recognizing the diverse and unique goals of each patient. As the first clinic to integrate diamorphine administration within comprehensive care, Praxiskombinat Neubau is at the forefront of ongoing research. Studies such as the perception of diamorphine therapy by users are crucial. Additionally, the clinic is exploring innovative treatments, including the use of psychedelics like ketamine.

Service Delivery Model

The clinic is dedicated to offering individualized care, particularly for those who are severely traumatized or suffer from severe forms of ADHD. The building includes consultation rooms, a smoking cabinet, social services, a diamorphine administration area, and resuscitation facilities. Patients also have opportunities to receive wound care, psychiatry and psychology support, and meals. The clinic is supported by a diverse and dedicated team, including 5 medical doctors, 6 social workers, 15 to 18 nurses, medical assistants, and specialists in wound care and languages.

Achievements and Impact

Since its inception, Praxiskombinat Neubau has achieved remarkable success in meeting individualized treatment goals and enhancing patients' quality of life. Some notable accomplishments include:

• Quality of Life: Many success stories abound, including individuals who have gone on to successfully manage their own restaurants and enjoy healthy family lives with their children.

• Health Improvements: A significant reduction in Hepatitis C cases.

• Hospitalization Reduction: Fewer days spent in hospitals for conditions like abscesses and endocarditis.

• Risk Reduction: Decreased risks of HIV and Hepatitis C transmission, and a reduction in overdose incidents.

Additional Insights

Many patients at Praxiskombinat Neubau have endured profound traumas, often stemming from experiences of war or sexual abuse. These cases highlight the necessity for comprehensive care that addresses the full spectrum of their needs, beyond just substance use treatment. While substance use itself is not classified as a disorder, it is a significant condition that demands specialized care. Praxiskombinat Neubau serves as a powerful example of how such care can dramatically enhance lives. Its model offers valuable insights that could be replicated elsewhere to support those grappling with substance use.

Arts and Substance Use

Leon Festinger's work on cognitive dissonance suggests that people have an inherent desire to achieve internal consistency or harmony among their beliefs, attitudes, and behaviors. When there is inconsistency (dissonance) among these elements, individuals are motivated to reduce it and restore harmony.

In the context of art and well-being, this means that engaging with art can be a way to help people achieve or maintain this internal harmony. Art can provide emotional and psychological benefits, helping to align an individual's internal state. For instance, creating or experiencing art can be a therapeutic activity that reduces stress, expresses emotions, and fosters a sense of peace and balance. Therefore, integrating art into care practices can support overall well-being by addressing the human need for internal harmony.

Tattooing

We talked with Dr. Kinkel about tattooing, and he mentioned that many patients get tattoos when they make a new decision. In the body of research, tattooing is almost always connected with blood-borne diseases in substance users. He added that tattoos sometimes represent a new goal or a new way of presentation. For others, tattoos can be a memoir of what they love and want to keep, or a presentation of what has meaning to them and can represent their identity.

Dr. Kinkel and his team have provided safe tattooing experts for these people to help them express their artistic expression guided by experts. It seems to me that art can be a way to offer treatment and consistency back to individuals.

Paintings

In the clinic, patient artwork and paintings are displayed all around, especially in the psychiatry room, which is filled with expressive art. The vibrant and fully expressive artwork sometimes calls for a normal life full of peace and beauty, while other times it reflects deeper, more complex emotions. Here are some of the featured paintings: (You can see more on the Global Health Canvas gallery page.)

Tranquil Companionship

Possible Interpretation

This scene represents an idealized view of relaxation and social connection, symbolizing leisure and escapism from everyday stressors. The individuals' healthy appearance may suggest that occasional indulgence in pleasures, such as drinking and smoking, can coexist with overall well-being when balanced with a healthy lifestyle.

A drawing of a devil and a pentagram

Possible Interpretation

This duality might reflect the complexity of how the artist perceives strength and power, aiming to externalize inner turmoil, find catharsis, or explore themes of power and rebellion, while also challenging societal norms, reflecting personal symbolism, or simply appealing to their aesthetic preferences through provocative imagery.

The Angry Man and His Fuming Hat

Possible Interpretation

This could symbolize a layered identity or a struggle with one's persona, suggesting an external facade that mirrors inner turmoil and anger.

Exposed Mind: Tears of Blood

Possible Interpretation

This might depict raw vulnerability and emotional pain, indicating psychological distress or a plea for understanding.

A woman crying with big tears

Possible Interpretation

Probably Large tears emphasize the intensity of the woman's sadness, representing a significant personal loss or a cathartic experience.

Imbalance of Mind and Form

Possible Interpretation

A person with a longer neck and a bigger head than body might symbolize an exaggerated sense of intellect or insight, possibly suggesting an imbalance between thoughts and physical presence. This portrayal could also emphasize vulnerability or a unique perspective, drawing attention to mental attributes over physical form.

These paintings explore themes of emotional complexity, internal conflicts, and perceptions of power and vulnerability.

The last word

Praxiskombinat Neubau demonstrates that incorporating artistic expression into comprehensive care can be essential for aiding individuals on their journey to recovery. By combining medical treatment, compassionate support, and artistic expression, the clinic offers a holistic approach that profoundly transforms the lives of its patients.