Harm reduction treatment offers practitioners a compassionate and pragmatic alternative to traditional abstinence-based approaches. Harm reduction therapy offers services with the goal of reducing the negative health and social consequences associated with abuse of alcohol and drugs without punishing people with stigmatic labels (e. g. alcoholic or addict). It also does not require a commitment to abstinence in order for the individual to obtain services.
Its primary treatment goal is the reduction of substance use through the provision of self-management strategies that are immediately effective in reducing personal and communal harm (Tatarsky, 2002). The focus of harm reduction is on moving the client through stages of change as she or he examines and reduces their substance use, meeting the client where they are in terms of their substance use, and bringing the client in as an active agent in forming their treatment plan (Miller & Rollnick, 2002).
The goal of harm reduction is the self-empowerment of the client, and the development of healthy coping skills and life skills as alternatives to continued alcohol and drug use. Harm reduction therapy approaches to alcohol and drug treatment rely on techniques such as motivational interviewing (Miller & Rollnick, 2002) and cognitive behavioral techniques that focus on relapse prevention, however relapse for that client may be defined (Marlatt and Donovan, 2005).
This approach is based on the premise that maladaptive drinking and drug use patterns are learned behaviors. Harm reduction utilizes interventions that attempt to identify contextual, social, affective, and cognitive precipitants of pathological substance use. Once the possible causes of maladaptive substance use patterns are identified (e. g. negative affect, stress, and social pressure to use), the treatment focuses on changing and/or reducing the influence of these precipitants.
In addition, treatment goals are derived from a conversation with the client as to what their needs for treatment are relative to their substance use. Often there is a desire on the part of the client to reduce negative consequences from their use, and often to reduce use itself. Harm reduction based approaches seek to utilize the client’s own goals and motivation for change in the service of assisting the client to benefit from treatment (Tatarsky, 2003). Clients who enter treatment come in a state of distress while being simultaneously engaged in their own process of change.
Harm-reduction-based interventions aim to support this process of change and seek to deepen the identification and understanding of what is distressing to the client. This allows the client, in collaboration with the therapist, to set harm reduction goals that are realistic and to work toward change with strategies that meet the client’s unique needs and strengths. The integrative approach of harm reduction combines a skills-building/self-management focus with an exploratory focus that serves to unwrap the meanings and motivations of substance use for that particular client (Tatarsky, 2002, 2003).
Skills can be learned and internalized in the therapeutic process. The direct teaching of coping methods in sessions with clients serves the direct goal of skill transfer, while simultaneously, and through ongoing relational support, helps the client internalize a capacity to function in more healthy and autonomous ways (Tatarsky, 2002). Harm reduction interventions are based on enhancing a client’s sense of self-efficacy as means of movement towards changes in use (Marlatt & Donovan, 2005).
Interventions encourage users to examine the impact of substance use on life goals, assist in helping clients identify triggers to use, and work with the client to develop coping skills and strategies to reduce use that are specific to their situation. The transtheoretical stages of change model (Prochaska, Diclemente, & Norcross, 1992) reminds harm reduction therapists that habit change is a journey with many potential obstacles and perils. Movement towards examining use and reduced use, like any other change process, involves a complex series of decisions.
People move through stages of change in regards to alcohol and drug use (Prochaska, Diclemente, & Norcross, 1992); many individuals who come into contact with substance abuse service providers will be in the precontemplation stage, with little desire to modify their substance use behavior in the near future but with some awareness that they are suffering. Important concepts in the stages of change theory include the fluidity of change and the importance of self efficacy in both the initiation and maintenance of change (Denning et al. , 2004).
A technique used in assessing the client’s place along the continuum of change and facilitating movement through stages of change is motivational interviewing (Miller & Rollnick, 2002). Motivational interviewing refers to a set of techniques and a general stance toward the client in which the therapist assumes that the client is usually ambivalent about his or her use of substances. Rather than clearly choosing sides in the debate about whether or not to use substances, the therapist encourages the client to continuously weigh the arguments for and against use in his or her own head.