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Our news & announcements offer up-to-date information important and relative for us to share with you. We update often, so check back frequently. Past news and announcements are available in this archive.
04/07/2009 - Harm Reduction
For as long as I can remember, the gold standard of substance abuse/dependence treatment has been complete and total abstinence from all mind-altering drugs. While this goal is clearly safe and appropriate, it does not take into account the significant number of patients who are not ready, or willing to stop. Mainstream treatment has not given this patient population any other option, and has used a broad-brush label of “being in denial” for these individuals. As such, the usual course of action is that these patients will drop out of intensive outpatient treatment or be referred to an even more intense level of care (i.e. inpatient) and ultimately be labeled as treatment failures.
In actuality, mainstream treatment continues to have poor levels of success by anyone’s criteria. The Substance Abuse and Mental Health Services Administration (SAMSHA) reported that for the five year period between 1992 and 1997, only 47% of patients completed American drug and alcohol treatment programs. Most clinicians in the field generally accept that relapse issues are acceptable, and expected during the course of treatment. The “disease concept” continues to be challenged by many and that abstinence is the only criteria for success.
For the past two decades, there have been isolated books and articles beginning with Alan Marlatt, Andrew Tatarsky, Edward Khantzian and others describing a paradigm shift that challenges the status quo and implores clinicians to take the patient “where they are at”. In other words, treatment must be individualized and the treatment provider must avoid the one size fits all philosophy of traditional programs. This approach is called Harm Reduction and is characterized by the flexibility to accept patients at any stage of the continuum. Emphasis is placed on smaller incremental changes, which reduce the harmful consequences of use, even while accepting that abstinence may be the best outcome. Harm Reduction also challenges the generally accepted notion that a patient must be “clean and sober” before therapy can be effective.
This philosophy is useful to both clinician and patient because of it’s flexibility and respect for the patient’s desires without a label (denial) or a mandate (complete and total abstinence) that will force the patient to discharge from treatment. Not all patients that present for treatment will meet the criteria for substance dependence; not all patients will go to twelve-step meetings or commit to working the steps; not all patients need medication, or even detoxification.
The door must be kept open for our patients without judgment or criticism. The multiple goals of treatment must include philosophical flexibility on the part of the clinician, which allows the patient to stay involved and committed. Harm Reduction is a useful and necessary framework to consider in the treatment of substance use disorders.