About Dr. Andrew Tatarsky

Dr. Andrew TatarskyAndrew Tatarsky is an internationally recognized leader in the treatment of substance misuse and other potentially risky behaviors. He has specialized in the field of substance use treatment for 30 years working as a counselor, psychologist, program director, trainer, advocate and author. He has devoted his career to developing a comprehensive understanding of the broad spectrum of substance use problems and an integrative harm reduction psychotherapy approach to treating this spectrum. This treatment is described in his book, Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems, and several professional papers that extend the approach. The book has been released in paperback, published in Poland by the Polish Office of Drug Prevention and is currently being translated into Spanish and Russian.

Dr. Tatarsky is Founder and Director of the Center for Optimal Living in NYC, a treatment and professional training center based on Integrative Harm Reduction Therapy (IHRP) for the spectrum of substance misuse and other high-risk behaviors. He earned his doctorate in clinical psychology from the City University of New York. He is a Clinical Advisor to the Office of Alcoholism and Substance Abuse Services of New York State, Founding board member and President-elect of the Division on Addiction of New York State Psychological Association, Chairman of the Board of Moderation Management Network, founding board member of Association for Harm Reduction Therapy and Chairman of Mental Health Professionals in Harm Reduction and Faculty, Advanced Specialization in Family and Couple Therapy, The Postdoctoral Program in Psychotherapy and Psychoanalysis, New York University.

CERTIFICATION PUBLICATIONS
EDUCATION PROFESSIONAL MEMBERSHIPS
TRAINING, CONSULTING & TEACHING EXPERIENCE NON-PROFIT BOARD MEMBERSHIPS
PROFESSIONAL PRESENTATIONS EDITORIAL BOARDS
CLINICAL EXPERIENCE INTERVIEW

 

Certification

  • New York State License to practice as a psychologist, July, 1987, No. 009253.
  • Certificate of Proficiency in the Treatment of Alcohol and Other Psychoactive Substance Disorders, the American Psychological Association College of Professional Psychology, October 1, 1996, No. AD003061.

Education

  • Candidate, 1991-Present, The Postdoctoral Program in Psychotherapy and Psychoanalysis, New York University; New York, N.Y.
  • Ph.D. in clinical psychology, The City College of the City University of New York; May 1986. Dissertation, “Cocaine Abuse and Psychological Functioning: An Exploratory Comparison of Recreational and Compulsive Cocaine Users”.
  • B.A. in psychology, The City College of New York, May 1977. Research Honors in psychology, summa cum laude, Phi Beta Kappa, Bernard A. Ackerman Research Award.

Training, Consulting & Teaching Experience

  • An Overview of Integrative Harm Reduction Psychotherapy. A half day training to Housing Works,Brooklyn, February 24, 2012.
  • Integrative Harm Reduction Psychotherapy: Theory and Technique. A one-day training at the NationalDrugs Conference of Ireland, Dublin, November 2, 2011.
  • Effective Psychotherapy of Substance Use Problems: An Integrative Harm Reduction Approach, A two day training sponsored by The Center for Optimal Living and The New School for Social Research, NYC, February 10-11, 2012.
  • Treating Substance Users across the Treatment Continuum: An Introduction to Integrative Harm Reduction Psychotherapy Rationale, Theory and Therapeutic Process.
    A one-day training sponsored by the Center for Integrative Psychotherapy for Addiction, New York, NY, September 17, 2010.
  • The Importance of Therapeutic Alliance and Integrative Harm Reduction Psychotherapy to Enhance the Effectiveness of Methadone Maintenance Treatment, A three-day training for MMT providers for Yunnan Institute of Drug Abuse, Kunming, China, September 1-3, 2010.
  • Integrative Harm Reduction: A New Way to Think about Behavior Change, a one-day training sponsored by Integrated Services of Appalachian Ohio, Athens, Ohio, May 13, 2010.
  • Integrative Harm Reduction: A New Way to Think about Substance Use Mental Health and Public Policy, a forum for state, county and community leaders sponsored by Integrated Services of Appalachian Ohio, Athens, Ohio, May 12, 2010.
  • Treating Drug and Alcohol Use in Family and Couple Therapy, a class taught in the Advanced Specialization in Couple and Family Therapy New York University Post Doctoral Program In Psychotherapy and Psychoanalysis, New York, March 9, 2010.
  • Integrative Harm Reduction Psychotherapy for the Treatment of Patients on Opiate Substitution Treatment, In-service training to the Opiate Treatment Program, Addiction Institute, New York, NY, March 31, 2010.
  • Integrative Harm Reduction Psychotherapy for Substance Using Patients/Clients: Rationale, Theory and Clinical Technique, a two-day introductory training for clinicians sponsored by Behavioral Services Center, Skokie, Illinois, February 18-19, 2010.
  • The Importance of Therapeutic Alliance and Integrative Harm Reduction Psychotherapy to Enhance the Effectiveness of Methadone Maintenance Treatment, A three-day training for MMT providers for Yunnan Institute of Drug Abuse, Kunming, China, October 20-22, 2009.
  • Overview of Integrative Harm Reduction Psychotherapy for Program Staff of the International HIV/AIDS Alliance of Ukraine, Kiev, Ukraine, July 30-31, 2009.
  • Improving the Quality of Harm Reduction Programs: A Three-day Training in Integrative Harm Reduction Psychotherapy for HIV and HEP-C Providers for The International HIV/AIDS Alliance of Ukraine, Kiev, Ukraine, July 27-29, 2009.
  • Hepatitis C and HIV: Integrating Harm Reduction into Existing Programs: A Two-day Introductory Training in the Integrative Harm Reduction Psychotherapy. The North Carolina Harm Reduction Coalition, Winston-Salem, North Carolina, June 26-27, 2009.
  • Case Conference Consultant, Training Unit, Bronx Psychiatric Center, New York, June 5, 2009.
  • Introduction to Harm Reduction Psychotherapy and Three Workshops presented at Different Approaches of Psychotherapy in Treatment of Addictions Conference, State Agency for Prevention of Alcohol Related Problems and Krakow Association of Help for Addicts, Krakow, Poland, May 13-15, 2009.
  • Seminar for Advanced Harm Reduction Psychotherapy Practitioners: A Two-day Training. Monar-Krakow and National Bureau of Drug Prevention, Krakow, Poland, May 11-12, 2009.
  • Integrative Harm Reduction Psychotherapy: Rationale, Theory and Clinical Process, a workshop given at the New York State Psychological Association’s 72nd Annual COnve3ntion, Saratoga Springs, New York, May 2, 2009.
  • Integrating Harm Reduction Psychotherapy into Your Practice, a half day training workshop, the Albert Ellis Institute, New York, April 3, 2009.
  • Talking to the Teenagers We Love about Drugs: A Harm Reduction Approach for Parents, a workshop conducted for the PTA of Bard High School/Early College, New York, March 11, 2009.
  • Effective Psychotherapy for Drug and Alcohol Users: Theory and Technique of Integrative Harm Reduction Psychotherapy,
    A one-day workshop presented at the Training Institute for Mental Health, New York, NY February 14, 2009.
  • Techniques of Integrative Harm Reduction Psychotherapy. A one-day training given to the Coalition of Behavioral Health Agencies, New York, NY, January 9, 2009.
  • Understanding and Engaging Co-ccurring Disorders: A Harm Reduction Approach. A one-day training given at the Coalition of Behavioral Health Agencies, New York, NY, December 19, 2008.
  • Integrative Harm Reduction Psychotherapy in a Case of Multiple Traumas, Dissociation, Suicidality and Life Threatening Substance Use, a case presentation at Trauma and Addiction, a conference sponsored by the Division on Addiction of New York State Psychological Association, New York University, New York, New York, November 21, 2008
  • Integrative Harm Reduction Psychotherapy 1: The Overview, workshop presented at the 7th National Harm Reduction Conference: Toward a National Policy, Miami, Florida; November 14, 2008.
  • Integrative Harm Reduction Ps ychotherapy 2: Clinical Dilemmas and Challenges, workshop presented at the 7th National Harm Reduction Conference: Toward a National Policy, Miami, Florida; November 14, 2008.
  • Psychology of Problematic Substance Use and its Treatment Implications, a workshop for the staff of National Advocates for Pregnant Women, New York, New York, October 31, 2008.
  • Advanced Clinical Workshop on Integrative Harm Reduction Psychotherapy, a one day workshop for the clinical staff of Fundacion (Parentasis), Santiago, Chile, October 2, 2008.
  • Comprehensive Introduction to Integrative Harm Reduction Psychotherapy: Six Sessions on History and Evolution, Philosophical Principles, Therapeutic Tasks and Techniques, Special Populations and Evidence and Evaluation, presentations at a two day Seminar: Harm Reduction Psychotherapy “New Treatment Strategies for the Problematic Use of Alcohol and Other Drugs” sponsored by Fundacion (Parentasis), Santiago, Chile; September 30-October 1, 2008.
  • Integrative Harm Reduction Psychotherapy with College Students. Workshop for the staff of Health and Counseling Services, Reed College, Portland, Oregon, August 29, 2008.
  • Building the Alliance with Patients. Half-day training give at the Effective Drug Treatment Seminar sponsored by the Austrian-American Foundation and the International Harm Reduction Development Program, Salzburg, Austria, July 16, 2008
  • Understanding and Engaging Co-Occurring Disorders: Harm Reduction Techniques. A one-day training given to the Coalition of Behavioral Health Agencies, New York, NY, May 30, 2008.
  • Outpatient Techniques of Harm Reduction Psychotherapy: Continuing treatment for consumers with co-occurring disorders in mental health outpatient settings, one-day training for Quality Impact COD Trainings, New York City Health and Mental Hygiene, Bellevue Hospital Center, New York, April 18, 2008
  • Building the Alliance with Patients. Half-day training give at the Treatment of HIV/AIDS Seminar sponsored by the Austrian-American Foundation and the International Harm Reduction Development Program, Salzburg, Austria, April 9, 2008.
  • Integrative Harm Reduction Psychotherapy. Half-day training given at the Effective Drug Treatment Seminar sponsored by the Austrian-American Foundation and the International Harm Reduction Development Program, Salzburg, Austria, October 11,2007
  • Building the Alliance with Patients. Half-day training give at the Effective Drug Treatment Seminar sponsored by the Austrian-American Foundation and the International Harm Reduction Development Program, Salzburg, Austria, October 10,2007
  • Harm Reduction Psychotherapy, Follow-up. Two-day advanced training for Monar-Krakow, Krakow. Poland, July 26 and 27, 2007.
  • Harm Reduction Psychotherapy. One and a half day training at the Harm Reduction Summer Institute sponsored by International Harm Reduction Development Program, Jagiellonian University, Krakow, Poland, July 24-25, 2007.
  • The Biopsychosocial Determinants of Drug Use. Half-day training at the Harm Reduction Summer Institute sponsored by International Harm Reduction Development Program, Jagiellonian University, Krakow, Poland, July 24, 2007.
  • Integrative Harm Reduction Psychotherapy: An Overview. Half-day training given to International Harm Reduction Development Program. New York. July 12, 2007.
  • Understanding and Engaging Co-Occurring Disorders: A Harm Reduction Approach. A one-day training given to the Coalition of Behavioral Health Agencies, New York, NY, June 21, 2007.
  • Harm Reduction Psychotherapy. Three-day training for Monar-Krakow and The Polish Office of Drug Prevention, Krakow, Poland. May 26-28, 2007.
  • Understanding and Engaging Clients with Co-Occurring Disorders: A Harm Reduction Approach. One- day training for The New York City Department of Health and Mental Hygiene and the Mental Health Association of New York City March 30,2007.
  • Integrative Harm Reduction Psychotherapy with Drug and Alcohol Users. Colloquium for the Clinical Psychology Doctoral Program , Long Island University, New York, March 8, 2007.
  • Harm Reduction Psychotherapy 102, a workshop presented at the Sixth National Harm Reduction Conference sponsored by the Harm Reduction Coalition, Oakland, November 11, 2006.
  • Harm Reduction Psychotherapy 101, a workshop presented at the Sixth National Harm Reduction Conference sponsored by the Harm Reduction Coalition, Oakland, November 10, 2006.
  • Introduction to Understanding and Engaging Clients with Co-Occurring Disorders: A Harm Reduction Approach. One-day training for The New York City Department of Health and Mental Hygiene and the Mental Health Association of New York City, September 15, 2006.
  • Using Harm Reduction Techniques with Clients with Co-Occurring Disorders, workshop presented at Understanding and Engaging Clients with Co-Occurring Disorders, New York University School of Social Work, Division of Lifelong Learning and Professional Development, New York, May 23, 2006.
  • Harm Reduction Psychotherapy with College Students, in-service training for mental health and medical staff of College Health Services at Sarah Lawrence College, Bronxville, N.Y., November 15th, 2005.
  • Harm Reduction Counseling with Active Drug and Alcohol Users I: Rationale, Philosophy and Theory, workshop presented at the 2005 National Health Care for the Homeless Conference, Washington, D.C. June 3, 2005.
  • Harm Reduction Counseling with Active Drug and Alcohol Users II: Therapeutic Process and Technique, workshop presented at the 2005 National Health Care for the Homeless Conference, Washington, D.C. June 3, 2005.
2004 – 2005
Conducted several workshops to staff of CitiWide Harm Reduction Program in the 2005 Bronx, N.Y. on dealing with vicarious traumatization, burnout and countertransference.
2000 – 1991
Faculty, Alcoholism Council of New York; New York, N.Y.

Teach:
The Psychodynamics of Addiction

An Integrated Approach to the Treatment of Alcoholism and Other Addictions

The Role of Education in the Treatment of Alcoholism Harm Reduction

  • Harm Reduction Psychotherapy with Active Substance Users: Clinical Rationale and Techniques, workshop presented at HIV-Meeting the Challenge: Strategies and Solutions Conference, Inova HIV Services, Northern Virginia HIV Resource and Consultation Center, George Mason University, Fairfax, Virginia, May 18, 1999.
  • Harm Reduction in Group Therapy with Substance Users, in service training presented to the clinical staff, Smithers Alcoholism Treatment and Training Center; New York, N.Y. November 6, 1997.
  • Effective Treatment of Substance Use Problems: A Harm Reduction Perspective, in service training presented to the clinical staff of the NYU Student Counseling Center, New York, N.Y., June 6, 1997.
  • Harm Reduction: Clinical Rationale and Applications, in-service training presented to the clinical staff, Smithers Alcoholism Treatment and Training Center; New York, N.Y. January 4, 1996.
1995 – 1996
Faculty, The Alcoholism Counseling Training Program, The New School For Social Research; New York, N.Y.

Taught: The Psychodynamics of Alcoholism

1991 – 1992 Adjunct Assistant Professor, Doctoral Program in Clinical Psychology, City College of the City University of New York; New York, N.Y.Taught: The Treatment of Substance AbuseConsultant, Postdoctoral Research Fellowship Program, Narcotic and Drug Research, Inc., New York, New York.Taught a five session mini-course: The Treatment of Chemical Addictions.
1991 Consultant, Postdoctoral Research Fellowship Program, Narcotic and Drug Research, Inc., New York, New York.Taught a five session mini-course: The Treatment of Chemical Addictions.
1987 – 1988
Instructor, Department of Psychiatry, University of Medicine and Dentistry of New Jersey; Newark, New Jersey.

Conducted colloquia and in-service training on psychodynamic and social-learning approaches to diagnosis and treatment of substance abuse.

Professional Presentations

  • Keeping Your Head When the Patient is Still Using: Integrative Harm Reduction Psychotherapy and theTherapist’s Countertransference. The spring lecture for the Psychoanalytic Psychotherapy Study Center,New York, March 24, 2012.
  • Introduction to Integrative Harm Reduction Psychotherapy. A talk to the National Association of SocialWorkers NYC Addiction Committee, New York, March 14, 2012.
  • Addiction is Not Just a Brain Disease: The Multiple Meaning of Substance Use and the CriticalImportance of Integrative Harm Reduction Psychotherapy. A plenary address to the National DrugsConference of Ireland, Dublin, November 3, 2012.
  • Effective Psychotherapy for Drug and Alcohol Users Across the Spectrum: Theory and Technique of Integrative Harm Reduction Psychotherapy, presented to the Behavioral Health Grand Rounds, North Central Bronx Hospital, Bronx, NY, March 24, 2010.
  • New Developments in Integrative Harm Reduction Psychotherapy, Talk presented to The HarmReduction and Mental Health Project, New York University, New York, NY., September 25, 2009.
  • Effective Psychotherapy for Drug and Alcohol Users: Theory and Technique of Integrative Harm Reduction Psychotherapy, Colloquium for The Department of Psychology, The City Colleage of New York, CUNY, New York, April 30, 2009.
  • Overview of Integrative Harm Reduction Psychotherapy, Grand Rounds, Division of Community and Public Health at Weill Medical College, New York, April 6, 2009.
  • Introduction to Integrative Harm Reduction Psychotherapy: An Evening Talk, the Washington Square Institute, New York, March 26, 2009.
  • Effective Psychotherapy for Drug and Alcohol Users Across the Spectrum: Theory and Technique of Integrative Harm Reduction Psychotherapy, Grand Rounds, Department of Psychiatry, Beth Israel Medical Center, New York, March 26, 2009.
  • Overview of Integrative Harm Reduction Psychotherapy, Grand Rounds, Albert Einstein College of Medicine/ Bronx Psychiatric Center, Grand Rounds, New York, March 13, 2009.
  • We are in the midst of a paradigm shift in our view of drug users and problematic drug use. A talk presented at Drugs, Pregnancy, and Parenting: What the Experts in Medicine, Social Work and the Law Have to Say, a conference sponsored by National Advocates for Pregnant Women, New York University School of Law and New York University Silver School of Social Work. New York University, New York, NY. February 11, 2009.
  • Harm reduction: What does it really mean? Panelist on Harm Reduction Month discussion, Housing Works, New York, NY. September 8, 2008.
  • Integrative Harm Reduction Psychotherapy: Rationale, Theory and Technique. Presentation at 2nd Annual Conference on the Treatment of Co-occurring Disorders, Alcohol and Substance Abuse Providers of NYS, Albany, NY, May 16, 2008.
  • Integrative Harm Reduction Psychotherapy for Problem Substance Use. Grand Rounds presented to The Addiction Institute of the Departments of Psychiatry at St. Luke’s and Roosevelt Hospitals, September 26, 2007
  • Therapeutic Alliance and Drug Treatment: Harm Reduction and Psychosocial Interventions. Paper presented at the European Association of Addiction Treatment Conference 2007, Vienna, September 10,2007
  • Integrative Harm Reduction Psychotherapy forDrug and Alcohol Users. The 2nd Annual Health Disparities Conference, Teachers College, Columbia University, March 10,2007
  • Understanding and Engaging Clients with Co-occurring Dsorders: A Harm Reduction Approach, Department of Psychiatry Grand Rounds, Woodhull Medical Center, Brooklyn, January 27,2007.
  • Moderation Management: A Harm Reduction Alternative to Abstinence-only Treatment, Drugs and Society Seminar, Columbia University, New York, October 18, 2006
  • Harm Reduction Therapy, Part II: Multiple Meaning of Substance Use and the Centrality of the Therapeutic Alliance, paper presented at The 1st National Harm Reduction Therapy Conference: Bringing Us Together, Addictive Behaviors Research Center, University of Washington, Seattle, May 5,2006
  • Harm Reduction Psychotherapy: Rationale, Theory and Technique. A poster presented at the 17th International Conference on the Reduction of Drug Related Harm, Vancouver, May 2, 2006
  • Harm Reduction Psychotherapy: The Biopsychosocial Process Model of Problem Substance Use, The Multiple Meanings Perspective and the Centrality of the Therapeutic Alliance, paper presented at Addiction Treatment in Metamorphosis: Paradigm Shift in Theory and Practice, Addiction Division of the New York State Psychological Association, New York, April 28, 2006.
  • Harm Reduction Therapy, presented at New Perspectives for the Prevention and Treatment of Addictions, a conference sponsored by Skoun, Lebanese Addictions Center, Beirut, Lebanon, October 8, 2005.
  • Harm Reduction Psychotherapy: Extending the Reach of Traditional Treatment, presented as part of a symposium Harm Reduction and Addictions Treatment: Contemporary Perspectives, Contemporary Visions at the College on Problems of Drug Dependence, Orlando, Florida, June 20, 2005.
  • Harm Reduction Psychotherapy, Substance Abuse Grand Rounds, Cornell Medical School, New York, March 10,2005.
  • Toward a Coalition of People Oppressed by Prohibition, presented at the Fifth National Harm Reduction Conference sponsored by the Harm Reduction Coalition, New Orleans, November 13, 2004.
  • Integrative Harm Reduction Psychotherapy: The Importance of Relationship and Therapeutic Alliance, presented the Fifth National Harm Reduction Conference sponsored by the Harm Reduction Coalition, New Orleans, November 12, 2004.
  • Recreational Drugs are Never the Real Problem, presented at Going to Far: When the Ordinary Becomes Addictive, presented by the Addiction Division, New York State Psychological Association, April 23, 2004.
  • Working with the Multiples Meanings of Drug Use: A Psychodynamic Harm Reduction Approach, colloquium presented at the William Allanson White Institute for Psychoanalysis, New York, November 4, 2003
  • Capacities for Change, presented at Substance Abuse Treatment: Clinical Challenges, Innovative Approaches, presented by the Addiction Division of New York State Psychological Association, New York, November 15, 2002.
  • Theoretical Rationale and Clinical Applications of Harm Reduction, presented at The Great Debate: Abstinence versus Harm Reduction in Addiction Treatment sponsored by the Addiction Division, New York State Psychological Association, New York, April 6, 2001.
  • Harm Reduction: The Philosophy and Clinical Rationale for Syringe Exchange, training to the Mental Health Board of Tompkins County, N.Y. for the Harm Reduction Unit of the AIDS Institute of the New York State Department of Health, November 10, 1998.
  • Harm Reduction Psychotherapy with Active Substance Users, presented at a mini-conference, Issues at the Cutting Edge of Addiction Treatment: Update 1998, at the Annual Conference of the New York State Psychological Association, Saratoga Springs, N.Y., October 10, 1998.
  • Harm Reduction Psychotherapy: Rationale and Clinical Technique, presented at the Second National Harm Reduction Conference sponsored by the Harm Reduction Coalition, Cleveland, Ohio, October 6, 1998.
  • Harm Reduction in Clinical Practice, presented at Harm Reduction in Clinical Practice: A New Paradigm for Working with People Who Use Substance, a conference sponsored by Mental HealthProfessionals in Harm Reduction, John Jay College of Criminal Justice, New York, N.Y., October 24, 1997.
  • The Clinical Rationale for Harm Reduction, presented at Psychotherapy with Active Substance Users, a workshop sponsored by the Division of Addiction, New York State Psychological Association, The Albert Ellis Institute, New York, N.Y. March 7, 1997.
  • Harm Reduction Psychotherapy, presented as part of the panel, Harm Reduction and Special Populations, The Seventh Annual Statewide Conference on AIDS, The AIDS Institute, New York State Department of Health, Albany, N.Y. February 26, 1997.
  • Harm Reduction and Psychotherapy, community forum, Gay Men’s Health Crisis; New York, N.Y., October 29, 1996.
  • Discussant, Relapse Prevention and Harm Reduction, a one day conference presented by Alan Marlatt, Ph.D., sponsored by Division on Addictions, New York State Psychological Association, The New York Medical School, New York, N.Y., October 25, 1996.
  • Harm Reduction Psychotherapy as Engagement Strategy, the First National Harm Reduction Conference, The Harm Reduction Coalition, Oakland, California, September 20, 1996.
  • Human Growth and Development: Their Relation to Substance Abuse and Addiction, The Importance of Addiction Credentials in the Age of Managed Care, co-sponsored by NYSPA’s Division of Addictions and The New School for Social Research, The New School, New York, N.Y., September 15, 1995.
  • Chair and Discussant, Undesirability as Countertransference Re-enactment, panel presentation, Psychoanalysis on the Edge: The Challenge of the ‘Undesirable’ Patient, Seventh Biennial Conference of the Psychoanalytic Society of the Postdoctoral Program in Psychoanalysis, New York University, March 1994; and the American Psychological Association’s Division 39 Annual Spring Meeting, Washington, D.C., April, 1994.
  • Issues of Adulthood in the Treatment of the Addictions, The Annual Conference of the Eastern Group Psychotherapy Society, Inc.; New York, N.Y., November 12, 1993.
  • Chair and Discussant, The Substance of Psychoanalytic Technique, the Annual Convention, American Psychological Association, Division 39, Toronto, Canada, August 1993.
  • The Critical Role of Psychotherapy in Long Term Recovery, Professional Training Workshop: Life Beyond Abstinence, The Washton Institute, New York, N.Y. May 22, 1992.
  • Working with Substance Abusers in Private Practice, Annual Conference, First Steps to Recovery, New York, N.Y. January 11, 1992.
  • Outpatient Treatment for Cocaine Abusers, Colloquium, Research Fellowship Program, Narcotic and Drug Research, Inc., New York, N.Y. May 6, 1991.
  • Structured Outpatient Approaches to the Treatment of Substance Abuse, Annual Convention, New York State Psychological Association, Montauk, N.J., May 5, 1991.
  • Intensive Outpatient Treatment for Chemical Dependency, Annual Convention, The American Psychological Association, New Orleans, La., August 12, 1989.
  • Cocaine and Crack: A Case Study, Grand Rounds, The Washton Institute, New York, N.Y., April 19, 1989.
  • Overview of Intensive Outpatient Treatment of Substance Dependence, Annual Convention, The New York State Psychological Association, New York, N.Y., April 10, 1989.

Clinical Experience

Present – 2002
Co-director, Harm Reduction Psychotherapy and Training Associates, a treatment and
Present – 1992
Founding Partner, PsychologicA; an organization providing psychotherapy, professional training and organizational consultation.
Present – 1987
Psychologist in Independent Practice, Individual, group and couples treatment.
1988 – 1991 Clinical Director, The Washton Institute on Addiction, New York, N.Y.
1987 – 1988
Clinical/Research Psychologist, Alcohol Treatment Center, Department of Psychiatry, University Hospital, Newark, New Jersey.
1984 – 1987
Clinical Director and Senior Psychotherapist, The DiMele Center for Psychotherapy, New York, N.Y.

Founded and directed the Cocaine Consultation Service.

1982 – 1984
Psychotherapist, Division of Drug Abuse Research and Treatment, Department of Psychiatry, New York Medical College, New York, N.Y.

Designed and implemented the Cocaine Abuse Treatment Program

1981 – 1982 Psychology Intern, University Hospital-Kings County Hospital Center, Brooklyn, New York
1978 – 1981 Psychology Extern, The Psychological Center, The City College of New York; New York, N.Y.
1979 – 1980 Director of Special Services, The Educational Alliance, New York, N.Y

Publications

Professional Memberships

  • Founding Executive Board Member, Association for Harm Reduction Therapy
  • American Psychological Association.
  • New York State Psychological Association.
  • Past-President, Division on Addictions, New York State Psychological Association.

Non-Profit Board Memberships

  • Member, Positive Health Project
  • Chairman of the Board, Moderation Management Mutual Help Network.

Editorial Boards

  • Harm Reduction, an on-line journal
  • International Journal of Drug Policy

Interview

I was trained in graduate school as a psychologist in a kind of integrative psychoanalytical perspective that honored the multiplicity of the different psychoanalytical perspectives as well as the value of cognitive-behavioral approaches. It was a way of thinking of human suffering and human problems in a very complex way that also showed the importance of individualizing any attempt to help people. I felt very lucky to be exposed to this kind of very interesting, diverse group of ideas. This was at the City College of New York Clinical Psychology program in the 1980s.

In the course of my training as a graduate student, I worked with some people who had problems with drugs and alcohol, but I never got any formal training in drug and alcohol counseling. Then, at an internship at King’s County Hospital in Brooklyn, I saw some patients that had some problems with drugs and alcohol. Again, I never really got any formal training but, in trying to think of how to work with these folks from within the perspective that I had been trained in graduate school, there was some success but also a lot of bumbling.

Later, by what appeared at the time to be by accident (in retrospect I don’t think it was completely by accident), I got my first job out of graduate school in a multi-modality treatment clinic up in East Harlem. There I got my first formal training – well, informal actually but real – in an addiction treatment approach that was really based on a kind of old-school addiction counseling mode that included 12-Step and was based in the disease model. I learned the whole paradigm that we’ve now come to describe as the “abstinence-only” model. Although I had been trained in a very different way, what I was being taught at the clinic (not that it was necessarily correct, mind you) in my entrance into the addiction field was that all of that complex psychological way of thinking was all well and good until it comes to trying to work with people with addiction problems: here’s this whole other model that is the only game in town and is the only one that really works. Again, this is what I was being told. So I learned that model somewhat uneasily. And I was left to try to reconcile these two apparently competing points of view.

Over the course of the next seven or eight years, I went on to develop and direct a few addiction treatment programs. I was the Clinical Director of one of the premier intensive outpatient programs in New York at the time. I was still working within this traditional paradigm; this was all in the late 1980s. We had some success and a lot of failure and we came to understand that, within the traditional framework, addiction is a very difficult disease or disorder to treat, that many folks are not ready for sobriety and that we were limited in what we could do – it was just the reality that we had to face up to. That never sat comfortably with me, I have to say, and, as the Clinical Director of this program, I was very interested in looking at outcomes and looking at our success. And over the course of the four years that I directed this program, it began to dawn on me with increasing clarity that we were failing to be of help to the overwhelming majority of the people that initially walked through our doors. It was like a dirty little secret that I was ashamed to admit to myself, let alone to anyone else. I was feeling kind of guilty – and ashamed and anxious and confused – and, ultimately, I came to feel that this was not an acceptable outcome for our treatment program and that the standard treatment model had to be challenged. We were blaming the patient for our lack of success rather than becoming curious about what might be wrong with the model and/or the treatment approach.

At this same time, I had the good fortune to start a private practice. In my private practice, I started getting calls from people who were actively using drugs and alcohol and who wanted therapy, but who were not necessarily clear about what they wanted to do about their drug use, or were certainly not ready to stop. Since they seemed to be good therapy candidates, I thought I would become more flexible and sort of see if I could work with them while they were actively using. I began to experiment with a kind of new approach that I think harkened back to my early training and to my continuing experiences of training and therapy and, lo and behold, many of the patients actually stayed in therapy. They were able to meaningfully engage; they began to address their drug use and their drug use began to reduce or in some cases stop; my clinical experience just didn’t fit with either the model that I had been taught back in East Harlem or at my then-current well-respected clinic. So these two experiences: 1) the failures of my treatment program and 2) my being able to be helpful to people who weren’t supposed to be treatable made it increasingly clear to me that there was another way.

I happened to have a relationship with Alan Marlatt (this was in about 1992), and I remember having a telephone conversation with him – me in New York and he in Seattle – and I said, “Alan, I’m having these treatment experiences with patients that I’m not supposed to be having: people are actually getting better in therapy!” And he said, “You’re doing harm reduction work.” I had never heard the term before. That was my introduction to the concept of harm reduction. Then Alan began to describe this concept as a kind of alternate paradigm, and it was as if the clouds parted and the sunlight shone through; suddenly everything began to make sense! It seemed to me that this new paradigm explained the failure of the traditional model and also explained why I was having success with my so-called untreatable patients. So, in 1992, my career took a 180 degree turn because harm reduction seemed to offer so much of value and benefit to everything that has to do with both understanding and being helpful to people struggling with addictions or having problems with substance use.

How I’ve come to understand harm reduction since then is that there’s a philosophy that’s embodied in harm reduction that we first learned about culturally through needle exchange. And this philosophy has certain fundamental principles that the handful of us who have been working as harm reduction psychotherapists have been applying in psychotherapy. These principles, I think, can be applied in different applications for different clinical populations. Essentially what they have to do with is really radical abandonment of a preconceived idea about who the client is, what the nature of the client’s problem is, what the client needs from you, and what you can offer that can be of help to that client. We’re challenged to put all of our own preconceptions aside and try to really understand what this person needs and wants and how we can be of help. It completely turns that traditional addiction treatment relationship on its head.Instead of coming in with a whole model about the nature of the addictive disease and what people need to do and the only way they can recover, we actually have to come in open and without seeing that kind of preconceived perspective of people as a kind of countertransference [Editor’s note: countertransference refers to a therapist's feelings about a client that originate from the therapist's own life experiences and issues] block that prevents us from being able to actually listen to patients.

What that suggests is that we need to listen to the patient and start from where the patient is motivated to seek help, which becomes the starting point of the treatment. And listening is the glue that strengthens or facilitates a strong therapeutic alliance, which is crucial in good treatment. Within that therapeutic alliance, we can then develop a collaborative relationship with people around the questions of what hurts, what’s harmful, what’s not working, what’s problematic and how they can begin to set meaningful personal goals in the direction of reducing what hurts or what’s harmful, and move in a more positive direction. This is the basis for the whole idea of small, incremental change: steps in the right direction. And what we see is that as people begin to reverse the negative spiral of addiction or problematic substance use and begin to make positive changes, a positive process of change gets set in motion. Small changes lead to other small changes as people begin to feel a little bit better. They feel more empowered and emboldened to take further steps in their lives, more confident about being able to change: like a wheel in motion, this change process gains momentum with each success.

As people begin to feel better, part of what’s fueling problematic substance abuse gets taken out of the equation and people’s relationship to the substance changes. They may now feel more conflicted about using in problematic ways. They’re more motivated to reduce their use or use in a safer way or to stop. They’re now increasing seeing that the important things in their lives, or values are now being threatened by excessive use. It’s about helping people to see more clearly what’s happening in their lives. If we think about the safe space of a harm reduction therapeutic context in which the therapist is non-judgmental, compassionate, accepting of all of the aspects of the person, we’re now inviting all of those aspects – their substance use, their reasons for using, their other interests in life, their aspirations that have been thwarted, their interest in health and growth – to fully come into the room, and now we can create a context that helps the individual grapple with the potential conflict or problems that their substance use may pose for their pursuit of these other interests. So now it would be possible to talk with people from the full experience of who they are, about whether, just maybe, there are other ways to resolve this ambivalence than continuing to do what they’ve been doing. It becomes possible, then, to think about new possible creative solutions, ways of resolving what is important to them in their lives including their drug use.

One of the things that continues to draw me to harm reduction is its focus on creativity, both for me and for my patients. And how within that creativity, free and open thinking is nurtured, leading both of us to experience a more positive encounter. I think that this creative thinking is also shown in our goal: to be maximally helpful to everyone who walks in our door. I acknowledge that I have limitations; each therapist does, and our limitations are going to frame to whom we can be helpful. Yet the more flexible, free, creative, and willing to be impacted by, molded by, and shaped by a client or our experience with the client – and draw upon whatever seems like it might be helpful – I think the more possibilities open up for how that therapy actually can be helpful.

This is why I think of myself as practicing integrative harm reduction psychotherapy because I wanted to integrate as much as we possibly can, or need to, into the services we provide. We need to be willing to give advice and make suggestions and talk about skills and strategies that might be valuable or useful to experiment with when that seems to be called for. Or, on the other hand, with some people, I need to be all about exploration and clarification, kind of keeping myself out of the way because that would be experienced by that particular patient as a kind of impingement or threat to their sense of autonomy. Other harm reductionists have a more doctrinaire way of doing harm reduction therapy, which I think runs the risk of becoming just what the old abstinence-only paradigm became: that is, the “‘there is only one way of recovering” kind of thinking. Some harm reductionists would say “well, we’re going to be only about empowerment and staying out of the client’s way, and we’re not going to give people what they need even when they’re completely out of control and need someone to step in and take charge because they can’t right at that moment.” An example of this is: what if your client was suddenly having a heart attack? You wouldn’t simply stand there and do nothing; that would be both unethical and non-humanistic. With substance abuse or other potentially dangerous behaviors, sometimes we have a similar obligation. The real challenge is to be able to use some combination of intellect and theory and intuition, dialogue, and negotiation to figure out with the client how they need for us to be in order for us to be most effective for them at this point in their lives. After all, we are service providers, and so we need to provide the service they want and need. Ultimately, we might need to be going in directions with our patients that we hadn’t anticipated before.

Harm reduction, as far as I’m concerned, embodies the key concept of moving in a positive direction. It values health and it values life, which is why, from my perspective, the person who is simply about empowering and destigmatizing the addict is not necessarily practicing real harm reduction – if that client is at risk to die or lose their kids or lose their job, then the therapist has a duty to intervene. When we see some clear and present danger that’s being imposed by somebody’s behavior, it seems to me a harm reduction framework would suggest that we somehow need to discuss it with our patient or intervene or attempt to engage the person in grappling with their risk in some way; we can’t simply ignore the risk.

Along with the values of destigmatizing and empowering is the value of understanding the other side of a client’s ambivalence, really understanding the reasons why they might still be using. Let me tell a story that I think will help to illustrate the different movements within harm reduction that I think are trying to co-exist or complement one another somehow. I think part of the struggle we’re having is because a lot of folks don’t come to harm reduction as I did – through a therapeutic door trying to help move clients in a positive direction and improve their quality of life or help them identify personal goals. Rather, a lot of people came into harm reduction as activists both to challenge the stigmatization of drug use and drug users that has contributed to inadequate health care for that population and to help us culturally to view the spread of HIV and AIDS and the incarceration of drug users, as prejudicial. So a) these folks don’t have clinical training and b) they have a different mission in a sense. Part of their job is to get “‘the man” off the drug users’ backs. I think most of us agree with this part of our job, but I don’t necessarily understand how that part of our job needs to be integrated with this other clinical agenda. So here’s the story:

I was supervising someone – this would be around the early 1990s I believe – a social worker, pretty well respected and working in a harm reduction center. He walked into the Day Room one day and Jose, a patient, was lying on a bench nodded out. The social worker looked at Jose and thought that he didn’t look very well. So he went up to the caseworker and said, “Hey, what’s up with Jose, he doesn’t look well.” The caseworker said, “Oh, Jose comes in every day; he just gets high and nods out. It’s kind of a safe space for him to chill. You know, just leave him alone; don’t mess up his high.” So the social worker said, “Hmm, okay, but he doesn’t really seem to be breathing very well. Have you checked in with him?” At this point, a few of the caseworkers started to get a little angry and said to the social worker, “Look, we know Jose and we’re telling you, just leave him alone. He comes in here everyday and this is just his safe space!” The social worker then started to get increasingly anxious. So he went up to Jose and bent down to listen to his breathing to see what was going on, and he noticed that Jose’s skin was pale. He thought to himself, “This man is overdosing!” And then said to everyone, “I think this guy is in serious critical condition. Would somebody call 911?” And the caseworkers started yelling at him to back off, so he went and called 911. The EMTs arrived in five or ten minutes and said if they had not arrived for another five or ten minutes, Jose would have been dead. So, here’s the punch line: who was practicing harm reduction in this scenario? I think they both were, but they need to find a way to live together – and certainly work together better – for the sake of the well being of the patient. This story is important to me because it showcases how we’re dealing with these broad, diverse groups of people who need different things – whether we’re talking about patients or therapists! So, from my point of view, harm reduction means adapting to meet the needs of different people.

Harm reduction psychotherapy also requires that we be both very skillful and very knowledgeable, which is one of the major shortcomings in the traditional drug and alcohol treatment field. And I should say this is true in the original harm reduction grassroots field as well. It is really a reflection of the stigmatization of drug users. That is, in this society we have decided that drug users, whether in harm reduction or traditional drug treatment, don’t need sophisticated help. They can benefit from untrained or poorly trained or para-professionally trained folks who have limited education, who care more than anybody and yet are generally quite limited in their knowledge and level of skill.

Instead, I think we’re arguing for, as harm reduction psychotherapists, the gold standard: harm reduction psychotherapists need to be highly skilled and highly educated and highly sophisticated and care more than anybody in order to bridge substance use issues with mental health issues along with the biopsychosocial issues that drug use reflects or is entwined with. So, we’re really arguing for elevating the entire field in a way.

Now, let me also say that I honor the tradition of self-help in AA and other 12-Step programs, of the therapeutic community movement, and of the grassroots harm reduction movement. All these movements evolved to meet the needs of people who were abandoned by the medical and psychiatric communities along with the rest of society. There’s something heroic and tremendously admirable about people stepping up to try to find ways to help one another to make up for this gap. But, then, as history moves on and now we have a whole treatment industry that is founded on being able to hire – to exploit – these folks and pay them poorly and train them poorly, now we’ve got an industry that has an investment in keeping things the way they are rather than upgrading the level of expectation and skill of these workers because it’s going to hurt the industry owners in their pocketbooks. All those certified alcohol counselors make their livelihoods on these jobs, so this change in the field must be a gradual process that respects these realities while still fighting for the gold standard in treatment providers’ skills. As with our clients, we need to bring many things to the treatment table including respect, with grassroots spirit and good clinical training skills, to assist clients in seeking their best life possible – their own “gold standard” if you will. Then we will really be practicing harm reduction psychotherapy.

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