Beyond Harm Reduction: A New Model of Substance Abuse Treatment Further Integrating Psychological Techniques.

Abstract

A new model of substance abuse treatment is proposed that emphasizes working on the process of behaviors in session and is based on integrating recent developments in psychological theory and technique (behavioral, cognitive–behavioral, and psychodynamic) into a harm reduction framework, with examples from a clinic that uses this treatment. Implications for program development, patient engagement, retention, sobriety, and overall functional improvement are explored. In recent years, major developments in the theory and technique of substance abuse treatment have emerged from the integration of the formerly disconnected world of psychology. The coming together of the two fields has led to the development of the theory of harm reduction (Marlatt, 1998) as it relates to substance abuse, the techniques of relapse prevention (Marlatt & Gordon, 1985), and the technique of motivational interviewing (Miller & Rollnick, 2002). While this integration has been occurring, major developments in psychological theory and technique have also taken place that have focused more attention on the process of what happens in treatment in an attempt to make changes in patients’ life outside of treatment. This has occurred in three theoretical areas of psychology: cognitive‐behavioral therapy (CBT; Safran & Segal, 1990); behavior therapy, with the development of dialectical behavior therapy (DBT; Linehan, 1993); and psychodynamic therapy, with the development of relational analysis (Greenberg & Mitchell, 1983).