Book review from Moderation Management’s website (www.moderation.org):
Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems
by Andrew Tatarsky, Ph.D.
This ground-breaking volume provides readers with both an overview of harm reduction therapy and a series of ten case studies that vividly illustrate this approach with a wide variety of clients, treated individually and in groups by different therapists. The stories are framed by commentary from Dr. Tatarsky, who draws out their therapeutic features and builds a powerful argument for harm reduction as an approach that meets clients where they live.
Research has found that it is easier for some people to begin counseling when specific goals are not required to enter treatment. In harm reduction therapy, any treatment goal that helps reduce harm to an individual is valid. Total abstinence, which may be an outcome of treatment, is one goal among several alternatives. Both abstinence and moderate drug and alcohol use fall under the umbrella of harm reduction.
This approach tailors the treatment to fit the individual, rather than forcing the individual into a treatment model. It employs the methods of psychoanalysis, in addition to cognitive-behavioral strategies, to engage the whole person, not just the addictive behavior. Key to this is helping the client, who is viewed as unique, not part of a problem population, to unlock the hidden meanings that his or her behavior expresses. Once identified, these meanings (or coping mechanisms) can be altered through a combination of psychoanalytic, cognitive, and behavioral techniques.
Though written primarily for clinicians, Dr. Tatarsky’s book provides valuable perspectives for laypersons who are considering moderating their drinking or abstaining from alcohol altogether. Many will identify with one or more of the individuals portrayed in the case studies: Tom, a gay museum curator who expresses his anger and depression in drunken behavior toward his coworkers; Gary, a physician whose bravado masks deep personal pain and who self-medicates rather than betray his vulnerability by asking for help; Diana, a single woman who uses wine to free herself from the critical inner voice of her mother. About half of the individuals portrayed choose moderation over abstinence.
Those in search of professional guidance will be encouraged to learn that there are clinicians out there who will help them to set and meet realistic and healthy goals, and do so with understanding and compassion. And although lay-led support groups like Moderation Management are outside the scope of the book, MM members will benefit from Dr. Tatarsky’s wise observations about the interconnection of emotions and behavior, and the incremental nature of personal change.
More about the book:
This book presents harm reduction as a new model for helping drug and alcohol users who cannot or will not stop completely (the majority of users) reduce the harmful consequences of using substances. Harm reduction accepts that abstinence may be the best outcome for many but relaxes the emphasis on abstinence as the only acceptable goal and criterion of success. Instead, smaller incremental changes in the direction of reduced harmfulness are accepted. Harm reduction hinges on the fact that substance users are a broadly diverse group of people who need individually tailored treatment that meet their unique needs and strengths. After a critique of the mainstream “abstinence-only” substance abuse treatment approach that prevails in the United States, the book shows how harm reduction’s simple but radical and profound changes in assumptions and expectation have dramatic implications for improving the effectiveness of psychotherapy with the full spectrum of problem drug and alcohol users.
The book introduces Tatarsky’s integrative approach to harm reduction psychotherapy. The approach blends a psychodynamic emphasis on the multiple meanings of substance use and the importance of the therapeutic relationship with a more strategic focus on the process of changing behavior. Then the book discusses the valuable contributions of the psychodynamic and cognitive-behavioral traditions to this work. Emphasis is placed on the “unwrapping” of the multiple personal meanings contained within or expressed by substance use and the development and strengthening of the capacities required for using these discoveries in the service of making positive changes in thought, feeling and action. Later chapters explore the specific value that harm reduction has for addressing the complexity of issues commonly associated with substance use, strengthening the therapeutic alliance, working with individuals who have experienced early trauma and when drug use functions as an attempt at coping or as a revolt against the “inner critical voice.” Chapters also discuss the value and limitations of traditional therapeutic community treatment, harm reduction groups, 12-Step programs and other alternative self-help groups such as Moderation Management.
The book is also a collection of stories. It is the story of Tatarsky’s own professional transformation from a traditionally trained substance abuse expert, through his disillusionment with the limitations of the traditional “abstinence-only” model, to his discovery of harm reduction as a philosophy, treatment theory and growing movement of clinicians, drug policy and criminal justice workers, researchers and academics. Each chapter also contains a detailed psychotherapy story that illustrates the theme of the chapter. All but one are contributed by other psychotherapists in the field. The stories show the range of treatment approaches that fall under the harm reduction umbrella and the variety of clients who can be treated by this approach.
What the experts are saying:
From the forward by Alan Marlatt, PhD, Director, Addictive Behaviors Research Center, University of Washington, Seattle.
“This ground-breaking volume provides readers with both an overview of harm reduction therapy and a series of ten case studies treated by different therapists that vividly illustrate this treatment approach with a wide variety of clients. In his introduction, Andrew Tatarsky describes harm reduction as a new paradigm for treating drug and alcohol problems. Some would say that harm reduction embraces a paradigm shift in addiction treatment, as it has moved the field beyond the traditional abstinence-only focus typically associated with the disease model and the ideology of the twelve-step approach. Others may conclude that the move toward harm reduction represents an integration of what Dr. Tatarsky describes as the “basic principles of good clinical practice” into the treatment of addictive behaviors.”
Stanton Peele, PhD, JD; psychologist, attorney and author.
“Harm reduction represents a new, but timeless, way of approaching substance abuse. It is based on four recognizable realities: (1) most substance abusers do not quit ‘using’ altogether, (2) substance abusers face multiple difficulties in life apart from their substance abuse, (3) current treatment is highly judgmental and rejecting, and (4) most people who suffer from their use of substances either do not attend or fail at current treatment options. The solution to these problems is to help people where they live, by recognizing and addressing the multitude of their problems, and by accepting all progress as beneficial and something to be built upon. In addition to the valuable techniques and information in this book, the cases present a primer in the realities of substance abuse treatment and its failure in the United States.”
Edith Springer, CSW; harm reduction consultant and master trainer.
“Andrew Tatarsky’s book, using cases submitted from different schools of thought, clearly elucidates the way harm reduction philosophy can be integrated into clinical work. The cases are varied, the practitioners have unique styles and varying approaches, and the realistic conclusions offer the reader a way to integrate slow, incremental change at the client’s pace into whatever model they currently use. No longer do therapists have to send people away to become abstinent before they can work with them; no longer do therapists have to feel responsible to set goals for their clients’ drug use. This is a must read for today’s psychotherapists who want to practice state-of-the-art-healing.”
Ethan Nadelmann; executive director, The Drug Policy Alliance.
“Personal dignity and responsibility as well as compassion and the recognition that one’s steps take place one day at a time are fundamental to both harm reduction and the 12-Step approaches to drug addiction. Tatarsky’s excellent new paradigm rescues these principles with courage, compassion and intellectual rigor. Harm reduction psychotherapy has come of age.”