Harm Reduction Finds its Place

The late G. Alan Marlatt may have been heartened to read William White’s interview with Andrew Tatarsky in this issue of Counselor.

An alcoholism researcher, Dr. Marlatt is still widely regarded the world’s leading proponent of the approach known today as “harm reduction.” For thirty years he was director of the Addictive Behaviors Research Center, an arm of the University of Washington in Seattle that nurtured a movement among therapists, holding that addiction treatment should take a more moderated approach than is common in traditional Twelve Step programs calling for complete abstinence.

In his book Relapse Prevention (1985), considered a seminal work in the field, Dr. Marlatt drew a distinction between a lapse and a full relapse. He postulated that a lapse can be seen as a warning sign, not as failure, and that addicts can get back on track through counseling.

While his approach gained some adherents, it has also been the subject of much debate and controversy.

Dr. Marlatt’s position was, essentially, “We’ll help you, whatever your goal is. You want to quit, we’ll help you. You want to cut back, we’ll help you. We’re not going to shut you out.” This view is not shared by most traditional treatment programs—they aren’t interested in working with clients who are not totally committed to abstinence.

While the prevailing wisdom is that those who meet the criteria for alcohol dependence are rarely, if ever, able to return to controlled drinking, it is also more widely accepted that abstinence is not always essential for people who drink too much but do not have serious problems.

Like Dr. Marlatt, Dr. Tatarsky has for thirty years championed the integration of harm reduction for treatment of substance abuse (see page _ ). Dr. Tatarsky describes a life-changing conversation with Dr. Marlatt in 1994:

I was describing my quandary, seeing the limitations of traditional treatment and the success I was having in working with active drug users. Alan said to me in that conversation, “You’re doing harm reduction.” That was like my spiritual awakening and a major paradigm shifting moment for me. Alan introduced me to harm reduction as an alternative framework for helping, which is really how I’ve come to see it. I saw harm reduction principles as having tremendously positive implications for psychotherapy, counseling and substance abuse treatment.

Today’s reality is that a harm reduction approach to substance abuse can and does exist side by side with more traditional forms of treatment.

Back in the day, not many of us could have imagined there would come a time when our field might accept the idea that abstinence would not be the only acceptable goal of treatment. We live and learn.

As Dr. Tatarsky says in this interview, there is a “paradigm shift and scientific revolution that is happening in our field right now.” The shift toward an integrative and collaborative treatment model can only be applauded, and we owe a debt of gratitude to trailblazers like Dr. Andrew Tatarsky and, of course, G. Alan Marlatt.