Psychotherapy and Drinkers – Harm Reduction, Alcohol, Suicide and Depression

It is understandable that a psychotherapist might object to doing therapy with a client who always showed up at sessions dead drunk and never, ever remembered one session to the net because he/she was in a blackout during the session.

However it is an outrage for persons seeking help with severe psychiatric problems to be refused psychotherapy because they have been drinking within moderate limits within the past several months.

I personally had the experience of being refused treatment for depression and suicidal ideation because I did not lie to the intake person and claim that I had six months of “sobriety”. At that point in time my drinking had been within perfectly moderate limits for the preceding month but because I told the truth I was refused therapy. This was at a hospital based provider that took Medicaid–and not in Podunk USA but in supposedly enlightened New York City. I am lucky to be alive.

All the evidence we have points to the idea that drug and alcohol users benefit from voluntarily sought psychotherapy regardless of their alcohol or drug use (Tatarsky, Dwnning). It is morally wrong and inhumane to refuse mental health services to people who choose to use alcohol or drugs. It is just as bad to stigmatize people for their alcohol or drug use as it is to stigmatize them for the color of their skin, their ethnicity, their religious beliefs or their place of birth.

The World Health Organization (WHO) has the following to say about depression:

“Major depression is now the leading cause of disability globally and ranks fourth in the ten leading causes of the global burden of disease. If projections are correct, within the next 20 years, depression will have the dubious distinction of becoming the second cause of the global disease burden.”

WHO also tells is that “Suicide is a leading cause of death for young adults. It is among the top three causes of death in the population aged 15–34 years…[S]uicide is predominant in the 15–34-year-old age group, where it ranks as the first or second cause of death for both the sexes. This represents a massive loss to societies of young persons in their productive years of life. Data on suicide attempts are only available from a few countries; they indicate that the number of suicide attempts may be up to 20 times higher than the number of completed suicides.”

WHO also tells us that “The most common mental disorder leading to suicide is depression, although the rates are also high for schizophrenia. In addition, suicide is often related to substance use ­ either in the person who commits it or within the family.”

And yet the United States is filled with psychotherapists who refuse to treat people for mental illnesses such as depression unless these people first abstain perfectly from all drugs and alcohol for six months.

Let us give three cheers for all the harm reduction psychotherapists like Dr. Tatarsky and Dr. Denning and many, many others who treat people for their mental health problems regardless of their alcohol or drug use.

Stigmatizing people for their drug or alcohol use and refusing them essential mental health services which might save their lives is–in the words of Penn and Teller–BULLSHIT!


WHO – The world health report 2001 – Mental Health: New Understanding, New Hope

Harm reduction psychotherapy : a new treatment for drug and alcohol problems / edited by Andrew Tatarsky with forward by Alan Marlatt.

Northvale, NJ : Jason Aronson, 2001.

Practicing harm reduction psychotherapy : an alternative approach to addictions / Patt Denning ; foreword by G. Alan Marlatt.

New York : Guilford Press, c2000.

Copyright © 2008, The HAMS Harm Reduction Network


About Kenneth Anderson

Kenneth Anderson is the author of the book How to Change Your Drinking: a Harm Reduction Guide to Alcohol. He is also the founder and CEO of The HAMS Harm Reduction Network.
This entry was posted in Alcohol, alcohol harm reduction, depression, harm reduction, psychotherapy, suicide and tagged , , , , , , , , , . Bookmark the permalink.

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