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GENERAL COURSE DESCRIPTION
About 30 years ago, when I was trained as a clinician, I was taught that when a client came to therapy with any substance abuse problem, I should focus only on the addiction and refuse to work on anything else until the client abstained. The notion of harm reduction hadn't made it into graduate school and post-graduate training. The paradigm was so strong that when a client who drank too much came to me because he was creatively blocked (he was an artist), and I chose to deal with both his creative block and his drinking at the same time, I never discussed the case with my supervisor. I felt that if I confronted my client about his drinking and insisted he abstain, he'd drop out of therapy. Instead, I focused on developing a relationship with him, while we explored how drinking interfered with his other goals, and we worked on his modifying his drinking while we got his artistic career back on track. When we terminated therapy a few years later, his drinking was under control and his career, which had been foundering (and for which he'd originally sought therapy) took off. (GC)
The field of addiction treatment has changed dramatically since then. Harm reduction is increasingly accepted among researchers and many clinicians as a legitimate approach to treating substance abuse. It has not-and it shouldn't and probably never will-supplant the treatment of total abstinence, but, as with treatments for other disorders like depression, rage and even schizophrenia, the idea that there is a one-best treatment that works best for everyone is dropping away.
This course will bring you up to date on the research and treatments for harm reduction. It is organized into four sections. The first section provides a definition of harm reduction, an overview of its principles, and preliminary ways to begin working with clients. The second section covers harm reduction issues and treatments with alcohol users. The third section covers harm, reduction issues and treatments with other substance users, including pregnant women. The fourth section furnishes additional harm reduction resources for clients and for therapists to learn more.
Disclaimer: This course is purely educational and does not intend to serve as a license (or permission) to mental health professionals to prescribe or practice any of the approaches discussed in this course unless they fall within the scope of practice of your profession. Check with your licensing board about the scope of practice of your profession to make sure you practice within that scope.
This course will teach the participant to
- State the justification for and background of harm reduction.
- Summarize basic principles of harm reduction treatment for substance users, alcohol users, and pregnant women who use substances.
- Apply suggested guidelines for deciding whether the better treatment for individual clients should be abstinence or harm reduction.
- Apply harm reduction treatments and techniques.
- Find additional resources for clients and for learning more about harm reduction.
- Definition and principles of harm reduction
- Myths and facts about substance use and users
- How to communicate effectively and establish alliances with substance users
- A model of harm reduction psychotherapy
- General principles
- Establishing an effective alliance
- Cooperative goal setting
- History of harm reduction
- 1980 Junkiebond movement in the Netherlands
- Surprising finding from the 1962 Maudsley study
- The Rand report and the Sobells' studies of the 1970s furnish more support for efficacy of controlled drinking
- Resistance from abstinence-only advocates
- The gap between what clinicians believe and what they practice
- A surprising survey of over 200 personnel at substance abuse agencies finds few agencies practice what they believe in
- Reasons for the gap between what clinicians and administrative personnel believe is effective and what they do instead
- Project MATCH: The largest study of alcohol treatments
- Objective of the MATCH
- Explanation of the three tested therapies: 12-step, Cognitive Behavioral, and Motivational Enhancement Therapy
- The findings: There is no one best treatment
- Guidelines for deciding which treatments to use with which alcohol users
- Which medication works better for abstention and which for harm reduction
- Five different types of alcohol users and treatment implications
- Motivational Interviewing: enlisting the client in making treatment decisions
- Harm reduction treatments for alcohol use that work
- Behavioral Self-Control Training
- Moderation-Oriented Cue Exposure
- Guided Self-Change
- What works with adolescents-and what doesn't
- School Health and Alcohol Harm Reduction Project
- Basic Alcohol Screening and Intervention for High-Risk College Student Drinkers
- Harm reduction treatments for other substance users
- Harm reduction treatments for opioid users
- Harm reduction treatments for cocaine addiction
- Medical, psychosocial and alternative medicine treatments
- The pitfalls of residential and limited residential programs
- Comparisons of abstention and harm reduction programs
- Harm reduction treatment with pregnant women
- Additional resources
- Resources for therapists to learn more about harm reduction
- Resources and support groups for clients
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