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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.
Educational Objectives:
This course will teach psychotherapists 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.
Course Syllabus:
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
To listen to Garry Cooper's Podcast on John Riolo's Insider Internet Radio show Click here.
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)
