This chapter introduces the clinician to the Irish people and to the key cultural features of their history and offers insight into the role of alcohol in Irish life and the current use of other substances in Ireland. Common treatment issues are reviewed and cultural guidelines are recommended. This chapter chiefly focuses on the Catholic Irish, for whom their ethnic identity is still a highly significant aspect of their lives. The author argues that, when handled with sensitivity, Irish Americans will embrace abstinence more easily than other ethnic groups. The key is to appreciate indirect language so that a therapeutic relationship can be established. A willingness to "talk around" an issue will usually be beneficial. Over time, the therapeutic process can become more direct, although increasing emotional awareness may be a slow process.