Harm reduction psychotherapy: an innovative alternative to classical addictions theory

Abstract

Harm Reduction Psychotherapy is an innovative treatment for people with alcohol and other drug problems. Unlike the traditional disease model of addiction, HRP uses a biopsychosocial approach to understand the complexities of drug use, abuse, and addiction. In other words, in the context of HRP, addiction is not the primary issue. Rather, it is an interactive phenomenon in which the relative weight of biology, psychology, and social factors varies for each person and for each drug he or she uses. HRP allows us to assess each person individually and to plan treatment that is tailored to the individual's relationship with alcohol and other drugs. It also incorporates other important problems: emotional disorders, family problems, social alienation, and medical complications. These issues are discussed at the beginning of consultation, without patients having to focus solely on their alcohol or drug problem. The unique aspect to HRP is that patients do not have to commit to abstinence as a condition of, or even necessarily as a goal of, treatment. HRP seeks to identify and work with the barriers to treatment adherence in any patient. It is clear that most medical patients have some difficulty understanding and adhering to medical recommendations and treatment protocols. However, drug users have particular problems that must be identified. HRP helps people create individual strategies to decrease harmful alcohol and drug use. It uses a nonjudgmental and collaborative approach to actively encourage individuals to explore their own barriers to change and to choose among a range of options such as abstinence, moderation, or other short-term goals. Motivational interviewing can be used to motivate behavioral change with the goal of reducing the effects of adverse consequences.