Bridging the Worlds of Harm Reduction and Addiction Treatment: An Interview with Dr. Andrew Tatarsky by Bill White for his Pioneer Series

Read an excerpt of Bill White’s interview with Dr. Andrew Tatarsky.

Find the full interview here.

Bill White: Are there other elements that distinguish harm reduction psychotherapy from more traditional addiction treatment approaches?

Dr. Andrew Tatarsky: I’ve come to see the harm reduction framework as offering a powerful, effective approach to healing and a corrective to much of what is wrong with the current addiction treatment system.

I’ve been more recently thinking about the paradigm shift and scientific revolution that’s happening in our field right now. We are now unfolding and increasing our understanding of the full spectrum of problematic substance use and addiction. The clinical implications of this involve a shift away from a one size fits all, authoritarian, prescriptive approach to treatment that says: “I know the nature of your problem, I know what you should do about it, and I’m going to try to get you to do it in any way that I can.” And that can be from a loving or, in some cases, very punitive and threatening approach to treatment. The shift is toward a collaborative model that empowers the patient to become actively involved in constructing, co-constructing the treatment from the beginning to the end.

(What are) the core principles in integrative harm reduction approach? One of the central principles is a shift from abstinence only—the position that abstinence is the only acceptable goal of treatment. Acceptance of that goal is often a prerequisite to entering and remaining in treatment. I think that that is one of the major stumbling blocks in the field. That position shuts the door on the majority of people that are struggling with drugs and alcohol who are not ready, willing, or able to embrace abstinence. I believe this includes nearly everyone at the point when they begin to become concerned about their substance use. The abstinence-only prerequisite is a tremendous obstacle for people to begin a therapeutic or a healing process and severely limits who can enter treatment. The fundamental harm reduction position is that we embrace any reduction in drug-related harm and any improvement in the issues that impact problematic drug use. This enables us to start the therapeutic process wherever the patient is ready to begin thus making therapy appealing and relevant to each patient. The harm reduction position of starting where the patient is amounts to lesson one in a first counseling or psychotherapy class, but it’s typically not what’s done in the addictions field. Harm reductionists are rigorously committed to starting where the patient is and, for me that translates into a primary emphasis on therapeutic alliance and collaboration throughout treatment.

Our interest is in seeing how we can create an alliance with a patient around goals and tasks that we agree on and to use that positive relational experience to inspire the patient to become and remain meaningfully engaged in the change process…People who struggle with substances are unique people within unique social and cultural circumstances. Our job is to help people find the path that bests suits them…We have to move from a one-truth model to a multiple truth model to achieve that.


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