Harm Reduction: The Growing Paradigm in Substance Abuse Treatment

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 three 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. Additional resources and references are provided for further study, but they are not part of the course.

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.It also does not serve as a permission to title yourself in any specific way.