Customer Reviews

Practicing Harm Reduction Psychotherapy: An Alternative Approach to Addictions

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Finally, a well-written book on harm reduction therapy! This book is a must read for all in the helping professions, particularly those who work with persons using substances. Dr. Denning, a seasoned and humane practitioner, explains harm reduction psychotherapy using a sound basis of theory and research which includes a blending of techniques from motivational interviewing, psychodynamic, cognitive-behavioral, and first and foremost, truly client-centered therapy. She describes it as what Zucker terms "informed eclectism". Case histories within the text enable one to implement these techniques with relative ease, in spite of the fact, that she makes clear we have too long over-simplified the treatment of substance users. Denning challenges practitioners to examine their beliefs about drugs, their use, and the people who use them. She calls on treatment providers to set a new standard of accountability for providing helpful substance use/abuse/dependency treatment. I have long believed that to label clients "resistant" or "in denial" tells me more about the therapist than the client. Denning's book describes a marvelous blend of psychodynamic, motivational interviewing, and truly client-centered therapy. It is a breath of fresh air to have a successful model of treatment which dispels widely accepted mythology about persons who use drugs. This is a true "First Do No Harm" approach. Dr. Denning's book calls us into the 21st century with a pragmatic, humane approach toward treating folks who are persons first, and drug users, second. I commend Dr. Denning for her courage in challenging the status quo of "one size fits all" treatment. Current acceptability of treatment for substance use is appalling. Would any of us accept rates of improved quality of life for only one out of every four persons treated by physicians? This book is testament in practice to "zero tolerance + zero compassion = zero." (Marlatt, 1998)

This is an amazing book. Finally, a book that talks about addiction and drug use in terms of the real relationship and complex interactions that people and their emotions have with drugs and alcohol. One that moves us away from the "all or nothing" concepts of the disease model of addiction, with its demands for total abstinence from all mind-altering substances as a condition for treatment. One that appreciates the deep and varied motivations for people to use drugs and alcohol, no matter how destructive their use has become.

From a sophisticated clinician, we get an understanding of how diverse people develop diverse relationships with drugs and alcohol. There is not, as the 12-step disease model of addiction tells us, a single disease course of addiction. Instead, people have various reasons for their dependence on drugs. AND, not everyone has a problem with every drug they use. Yes, drug use and abuse is as complicated as I thought. Thank you, Dr. Denning.

Denning talks about mental illness, dual diagnosis and the self-medicating tendency of people who have significant emotional problems. This is the most humane and useful treatment of the subject that I have read.

Denning gives us a road map for an alternative means of assessment and treatment that is readable and useable. The most important aspects of the treatment process are its emphasis on collaboration, its respect for clients' self-knowledge and expertise, its accounting for the role of motivation and attachment in changing behavior, and the understanding that changing addictive behavior is an incremental process if it is an authentic one.

Finally and overall, in challenging traditional concepts of addiction, Denning gives a cogent account of the origins of harm reduction in public health efforts to prevent the spread of HIV, explains what it really is in clinical practice, and refutes the hysterical myths about it being a Trojan Horse for drug legalization. Instead, harm reduction saves lives and engages many more people in a treatment process than have been reached up to now. This book treats addiction with a combination of common sense and clinical sophistication that many of us have craved for years, if not decades.

Dr. Denning has written the definitive text for therapists seeking an effective alternative to traditional disease model therapy. I highly reccomend this book for experienced practitioners and those new to the field.

While this book is useful to those who are new to the field or those who rigidly practice one approach to addictions counselling it is not helpful for experienced workers. The authors explore some really basic material (cycle of change, motivational interviewing, etc) and claim that this is somehow new. The overall approach (client centered) is useful but lacks depth.

While this book is useful to those who are new to the field or those who rigidly practice one approach to addictions counselling it is not helpful for experienced workers. The authors explore some really basic material (cycle of change, motivational interviewing, etc) and claim that this is somehow new. The overall approach (client centered) is useful but lacks depth.