Andrew Tatarsky

I have come to believe in the necessity of integrating cognitive and behavioral elements into psychotherapy with clients who have problems with substance use. I have also come to understand the use of these techniques as consistent with harm reduction.

The thread that runs through the variety of psychoanalytic approaches that currently exist is the idea that human behavior is shaped and driven by a number of different elements within each individual that are personally meaningful and that a conscious awareness of these meaningful elements increases our possibilities for greater choice and freedom in our lives.

Mainstream abstinence-oriented treatment of alcohol and drug users in the United States today continues to have poor success by anyone's criteria. Clinical observations and empirical studies typically report that a majority of clients seen initially do not successfully complete treatment or maintain their gains after treatment.

Harm reduction is the most recent of these important new ideas in the substance use treatment field. It heralds a paradigm shift in the way we understand and respond to problematic drug and alcohol use. Harm reduction rejects the presumption that abstinence is the best or only acceptable goal for all problem drug and alcohol users.

Is a guy who goes out several evenings after work with friends and often gets drunk sharing a meaningful social experience?  Or is he killing time, zoned out to avoid dealing with the depressing emptiness of his life? Is a college student who uses speed to cram for a test just using it to stay up later to get in more studying? Or is she self-medicating  ADD (Attention Deficit Disorder), or trying to make up for a semester of missed schoolwork because of paralyzing anxiety and insecurity about her intelligence?

Ethan Nadelman, executive director, Lindesmith Center Drug Policy Foundation: 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 12-steps 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.

The paper presents harm reduction's rationale, principles, treatment implications, and application to psychotherapy. The author describes his model of Integrative Harm Reduction Psychotherapy.