A few years ago I read Andrew Tatarsky’s book “Harm Reduction Psychotherapy”. This is an excellent book which I highly recommend to anyone interested in dealing with drug or alcohol problems or working with clients who deal with the same. This book collects case histories of several clients treated by various therapists. Tatarsky is the editor–the chapters were written by various therapists. I plan to reread this soon and write a more in depth article about it–however, this book recently popped into my mind and I wished to make some blog comments about what I remembered about it. If my memory errs–please forgive me.
The 12 step/abstinence-only model tells therapists that they must not waste their time doing any sort of psychotherapy with drug or alcohol users–these “lepers” can only benefit from psychotherapy after a long period of abstinence which can be granted them only through indoctrination in a 12 step/abstinence-only program. This is because their supposed “addictive brain disease” precludes any benefit from any sort of psychotherapy.
Dr. Tatarky was quite brave in saying that giving psychotherapy to people who were still using drugs or alcohol could help them to stop using.
However–the predominant message I get from Dr. Tatarsky’s book is something which could better be characterized as “use extinction” rather than “harm reduction”. As I recall, therapists saw clients who were actively using drugs or alcohol– and successful outcomes weer those which involved abstinence from alcohol and drugs and AA attendance (if I recall correctly one successful outcome was drinking within MM limits).
I applaud Dr Tatarsky in championing psychotherapy for people who are not abstinent from drugs or alcohol. I personally have been refused psychotherapy at an extremely stressful period in my life because I was honest enough to admit that I had been through alcohol treatment previously and that I now drank unproblematically.
However–a purely harm reductionistic approach should not assume the elimination of recreational drug use or recreational alcohol intoxication as a goal. I got the feeling from the book that the therapists who contributed articles were imposing their personal values on the people who received therapy–and that therapy was only considered successful if and when the client accepted the goals which the therapist felt that the client ought to accept–i.e. abstinence.
Refusing therapy to someone who chooses recreational drug use or recreational alcohol intoxication is as bad as refusing medical treatment on the grounds of race or religion or sexual orientation. It is pure antihumanistic discrimination. Although people do not choose their race–they do choose their religion–and they also choose their forms of entertainment–such as recreational drug use or alcohol intoxication. This does not make them “lepers” who should be denied a needed medical treatment such as psychotherapy.
The purely harm reductionist approach should offer psychotherapy to people even if they choose to continue to enjoy recreational drug use or recreational alcohol intoxication.
The goal should be to help a client become a happy and healthy individual who likes him/herself.
We should no more attempt to “cure” someone who likes to overdrink a bit than we currently attempt to “cure” homosexuals. Homosexuality was officially a “disease” in the United States according to the DSM until 1974. In 1974 it became an “un-disease”.
It is past time that recreational drug use and recreational alcohol intoxication were un-diseased as well
Using psychotherapy to get an active drug or alcohol user to abstain should properly be called “use extinction”. This is in contrast to a pure harm reductionist model which respects the individual and which recognizes the individual’s to choose his/her own goal regarding intoxicants–which may include continued use.
Let us once and for all separate the issues. If someone requests psychotherapy let us give it to them regardless of race, color, creed, sexual orientation or choice of recreations.
I still find TV more addictive than alcohol and am on a major abstinence from watching TV.