Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems [Paperback]

Andrew Tatarsky (Editor)

Book Description

Publication Date: June 10, 2007 | ISBN-10: 0765703734 | ISBN-13: 978-0765703736

This ground-breaking volume provides readers with both an overview of harm reduction therapy and a series of ten case studies, treated by different therapists, that vividly illustrate this treatment approach with a wide variety of clients.
Harm reduction is a framework for helping drug and alcohol users who cannot or will not stop completely—the majority of users—reduce the harmful consequences of use. Harm reduction accepts that abstinence may be the best outcome for many but relaxes the emphasis on abstinence as the only acceptable goal and criterion of success. Instead, smaller incremental changes in the direction of reduced harmfulness of drug use are accepted. This book will show how these simple changes in emphasis and expectation have dramatic implications for improving the effectiveness of psychotherapy in many ways.

From the Foreword by Alan Marlatt, Ph.D.: “This ground-breaking volume provides readers with both an overview of harm reduction therapy and a series of ten case studies, treated by different therapists, that vividly illustrate this treatment approach with a wide variety of clients. In his introduction, Andrew Tatarsky describes harm reduction as a new paradigm for treating drug and alcohol problems. Some would say that harm reduction embraces a paradigm shift in addiction treatment, as it has moved the field beyond the traditional abstinence-only focus typically associated with the disease model and the ideology of the twelve-step approach. Others may conclude that the move toward harm reduction represents an integration of what Dr. Tatarsky describes as the “basic principles of good clinical practice” into the treatment of addictive behaviors.
“Changing addiction behavior is often a complex and complicated process for both client and therapist. What seems to work best is the development of a strong therapeutic alliance, the right fit between the client and treatment provider. The role of the harm reduction therapist is closer to that of a guide, someone who can provide support an

Editorial Reviews

Review

Personal dignity and responsibility as well as compassion and the recognition that one's steps take place one day at a time are fundamental to both harm reduction and 12-step approaches to drug addiction. Tatarsky's excellent new paradigm rescues these principles with courage, compassion, and intellectual rigor. Harm reduction psychotherapy has come of age. (Ethan Nadelman )

Although this book is a good read for substance misuse specialists too, its readership should be predominantly out with the specialist field. It should be on the bookshelves of the legions of individual psychotherapists who claim no expertise with substance misusers, but who are probably working with some anyway. (Addiction Research And Theory )

Andrew Tatarsky's book, using cases submitted by practitioners from different psychological schools of thought, clearly elucidates the way harm reduction philosophy can be integrated into clinical work. The cases are varied, the practitioners have unique styles and varying approaches, and the realistic conclusions offer the reader a way to integrate slow, incremental change at the client's pace into whatever treatment model they currently use. No longer do therapists have to send people away to become abstinent before they can work with them; no longer do therapists have to feel responsible to set goals for their clients' drug use. This is a must-read for today's psychotherapists who want to practice state-of-the-art healing. (Edith Springer )

About the Author

Andrew Tatarsky, Ph.D., holds a doctorate in clinical psychology from City University of New York. He has a private practice in New York City specializing in harm reduction psychotherapy with drug and alcohol users and is co-director, with Dr. Mark Sehl, of the Harm Reduction Psychotherapy and Training Associates, a treatment and training organization. His perspective on substance use problems has evolved over twenty years of experience working in the area as psychotherapist, supervisor, program director, teacher, writer, and public speaker. He is a founding member and Past President of the Addiction Division of the New York State Psychological Association and Chairperson of Mental Health Professionals in Harm Reduction.

Product Details

• Paperback: 392 pages
• Publisher: Jason Aronson, Inc. (June 10, 2007)
• Language: English
• ISBN-10: 0765703734
• ISBN-13: 978-0765703736
• Product Dimensions: 8.8 x 6.2 x 1 inches
• Shipping Weight: 1.2 pounds (View shipping rates and policies)
• Average Customer Review: 4.8 out of 5 stars  See all reviews (4 customer reviews)
• Amazon Best Sellers Rank: #536,579 in Books (See Top 100 in Books)

More About the Author

Andrew Tatarsky received his doctorate in clinical psychology from the City University of New York. He has a private practice in New York City as a psychologist specializing in integrative harm reduction psychotherapy with substance users and their families. He is co-director of Harm Reduction Psychotherapy and Training Associates, a treatment and training organization in New York City. He has specialized in the field of substance use treatment for over 25 years working as a counselor, psychologist, program director, trainer, advocate and author. He has taught at the New School, The City College of New York, The Alcoholism Council of New York , National Development and Research Institute and the Harm Reduction Summer Institute at Jagellonian University. He is a founding member and past president of the Division on Addiction of New York State Psychological Association, Chairman of the Executive Board of Moderation Management Network, founding executive board member of the Association for Harm Reduction Therapy and founding chairman of Mental Health Professionals in Harm Reduction. He is also on the board of directors of the Positive Health Project and the editorial boards of the Harm Reduction Journal and the International Journal of Drug Policy. His book, Harm Reduction Psychotherapy: A New Treatment for Dug and Alcohol Problems, has been released in paperback, published in Poland by the Polish Office of Drug Prevention and is currently being translated into Spanish and Russian. He trains nationally and internationally.

Customer Reviews

Most Helpful Customer Reviews

21 of 22 people found the following review helpful:

5.0 out of 5 stars Move over AA, there's a new kid on the block, July 18, 2002

By 

Robert L. Cohen (New York, NY USA) - See all my reviews
(REAL NAME)   

This review is from: Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems (Hardcover)

Andrew Tatarsky and his contributors have brought the honesty, the sympathy, and the efficacy of harm reduction into the treatment of substance users, and it's about time!

"Just Say No" has failed 95% of drug users who seek treatment to have better control over their life and their substance use. It has failed them because drug use is not a disease, and abstinence is not a cure. Men and women (and young men and young women) use drugs for their benefits, although drugs, of all kinds --licit and illicit-- are not without their risks.

However the risk of developing a drug (and/or alcohol) problem does not derive solely from the drug. Tens of millions of people have had positive experiences with alcohol, marijuana, opiates, and psychydelic substances. Doesn't it make sense to identify what internal and what external factors cause a particular individual to suffer from a drug problem, rather than proclaiming drug use itself as a sickness.

Standard abstinence therapies and their institutions function by glorifying guilt, helplessness, and continuous self degradation. Standard abstinence therapy fails the overwhelming majority of people.

Tatarsky's book demonstrates, through well written and sympathetic case studies, another way to help people who have problems with their drug use, and it seems to be a better way. This book can make a huge difference in the lives of millions of people.

14 of 14 people found the following review helpful:

5.0 out of 5 stars A More Humane Approach, August 6, 2002

By A Customer

This review is from: Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems (Hardcover)

Those of us who struggle to control our own alcohol or drug use, or who live with someone who is trying to cut down or quit, may greet the harm reduction approach, persuasively presented by Dr. Andrew Tatarsky, as good news indeed. A practicing psychotherapist, Tatarsky is concerned with meeting clients "where they live": In the context of drug and alcohol abuse, this entails exploring the meanings these substances hold for the individual user and grounding the therapy in the process of self-discovery---rather than requiring abstinence from the outset, which is the traditional "one-size-fits-all" approach to counseling.

The book describes ten cases, each from a different therapist who practiced "harm reduction" in treating his or her client. Many readers will be both riveted and moved by the experience of peering into these intimate sessions. The stories are well told (if somewhat unevenly written), and their subjects come across as real people. Even more compelling is Tatarsky's framing commentary, which draws out the significance of each case: the complex interaction of personal and social factors that led this particular individual to seek meaning (liberation, escape, validation) in drug use.

As to alcohol abuse, which is a component in most of these case studies, the harm reduction approach is controversial in not prescribing an outcome from the start. It flies in the face of conventional wisdom, which holds that "problem drinkers" (read, alcoholics-in-the-making) lose control after just one or two drinks. The individuals portrayed so appealingly in this book are empowered by their therapists to explore the space between quitting altogether and drinking to excess. About half of them achieve stable moderation; the others discover for themselves that abstinence is the more comfortable and successful route to reducing the harm in their lives.

Readers who are not clinicians but worry about these matters will find fresh insights in this accessible introduction to harm reduction. Personal change is an intensely emotional journey best undertaken in the company of a wise therapist or caring support group. The book should be read by every psychotherapist, social worker, and counselor who deals with problems of substance abuse, directly or indirectly---that would be just about all of them. Then, they might wish to recommend the book to those of their clients who are ready for it. This layperson was able to identify with both clients and clinicians, engaged together in life-changing work.

5 of 5 people found the following review helpful:

5.0 out of 5 stars Harm Reduction - Not a Paradigm Shift, but a Re-Birth of Good Therapy Paradigm, September 29, 2008

By 

Pavel Somov, Ph.D., author of "Lotus Eff... - See all my reviews
(VINE VOICE)   

This review is from: Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems (Paperback)

In my opinion, there are four post-12-step classics: Marlatt's "Harm Reduction," Peele's "Diseasing of America," Miller & Rollnick's "Motivational Interviewing," and Tatarsky's "Harm Reduction Psychotherapy." My suggestion - buy all four, read all four.

Marlatt's "Harm Reduction" is a historically first (if I am not mistaken) overview of harm reduction paradigm. Peele's "Diseasing of America" is an intense but poignant critique of the 12-step "recovery industry." Miller & Rollnick's "Motivational Interviwing" is a primer on harnessing pseudo-resistance and leveraging motivation for change. Tatarsky's "Harm Reduction Psychotherapy" is a straight-forward harm reduction application book that starts its chapters from a panoramic bird's-eye view and then clinically bomb-dives into the application specifics.

The book consists of 10 chapters, each consists of a nuanced analysis of the issues at hand with a relevant and indepth case study. Like all harm-reduction literature the book bristles with humanistic courage: it meets the clients "really" where they are, it validates the existential and adaptive valence of substance use, it encourages a clinically "libertarian" stance of respecting clients' goals, it bridges harm reduction with psychoanalysis and cognitive-behavioral schools of thought, it humanizes the substance use population by debunking the preconceived notions and assumptions that still bias so many of the front-line substance use providers, and most importantly the book reminds us that harm reduction is nothing new, that, in essence, it is not a new paradigm but a return to the good ol' humanistic, non-reductionistic, non-oversimplifying, client-centered clinical stance.

I remember one of my first practicum sites. I was sharing - no, not an office wall, - a hallway with a Certified Addiction Counselor. This counselor, bless his good intentions, literally yelled and screamed at his clients loud enough for my own clients - across the hallway and behind the tightly shut door - to raise their brows. I don't mean to say that all CACs are like that. But this one - with Orwellian orthodoxy - was toeing a party line of abstinence with the cheer-leading vigor of the Volga bargemen, intoxicated with his own rightseousness...

Tatarsky's book offers the dichotomizing "preachers" of the 12 Steps a humanistic out - by recognizing a whole spectrum of grey in between the black and white extremes of Abuse-Abstinence continuum, substance use clinicians no longer have to yell - in frustration - that anything that isn't white must be therefore black. Tatarsky's book reminds us not to over-simplify the meaning of substance use and illustrates this point particularly well in Ch. 5: "Complex Problems Require Complex Solutions."

Tatarsky's "Harm Reduction Psychotherapy" is about that client-centered therapeutic silence that allows the clinician to tune in to the subtle winds of change that draft in between clients' pseudo-resistence responses.

As such, Tatarsky's book is a rehab for those who run rehabs!


Pavel Somov, Ph.D.
Author of "Eating the Moment: 141 Mindful Practices to Overcome Overeating One Meal at a Time" (New Harbinger, Nov. 2008) - a harm-reduction application to emotional eating; and author of "Recovery Equation: Motivational Enhancement/Choice Awareness/Use Prevention: an Innovative Clinical Curriculum for Susbstance Use Treatment (Booksurge, 2003).


http://www.eatingthemoment.com/logotherapy-addiction/
http://www.eatingthemoment.com/psychodrama-addiction/
www.drsomov.com