Synopses & Reviews
Review
"Harm reduction has been recognized as an evidence-based practice component, and Patt Denning's book provides social work students an alternative view of substance abuse and recovery. The book's emphasis on reducing the harm of substance abuse is a long overdue alternative to the disease approach. In addition, it is consistent with a strengths perspective as it emphasizes progress over pathology."--Tom Broffman, PhD, LICSW, Department of Sociology, Anthropology, and Social Work, Eastern Connecticut State University
"This book is recommended reading for all therapists, social workers, counselors, and students training for these professions. For too long, practitioners have worked out of extremist, 'all or nothing' models whose strategies have proven to be unsuccessful with most clients who come to us with problems and also happen to use drugs or alcohol. Based in research data and clinical experience, Denning's model truly reflects client-driven therapeutic practices and interventions. The book broadens the clinician's understanding of the role of drug use in the person's life and the effects of chronic drug use on the person's capacity for self realization. Liberally peppered with case vignettes, it provides a full 'tool kit' of strategies and interventions to help clients maximize their health, happiness, and contentment with their lives." --Edith Springer, ACSW, Senior Trainer, Harm Reduction Training Institute (a joint project of the Harm Reduction Coalition and the Lindesmith Center/Open Society Institute), New York City
"An excellent and long overdue work. While interest in harm reduction has burgeoned over the past decade, relevant professional resources have barely kept up with the pace. This book is highly integrative and inclusive, inspired by the disciplines of public health, cognitive-behavioral therapy, personality theory, traditional addiction treatment, motivational interviewing, relapse prevention, and more. Denning makes extensive use of case examples, and these examples reveal that she is a seasoned, well-informed clinician. Along with clinical success stories, she courageously presents the 'failures' that led her to the practice of harm reduction psychotherapy. Clinicians will recognize their own patients (and clinical struggles), and they will learn harm reduction strategies that make sense. I recommend this book to anyone interested in addiction treatment." --Bruce S. Liese, PhD, ABPP, Professor of Family Medicine and Psychiatry, University of Kansas Medical Center
"This courageous and compellingly honest book is at once a professional autobiography, a primer on addictive behavior, a casebook, a reminder about the basics of the psychotherapeutic relationship, and a call to action. Denning is a mature clinician who shares with us the process and fruits of her development as a psychotherapist specializing in addiction and multidiagnosis clients. To replace the outdated conception of addiction as a disease, she explicates harm reduction psychotherapy, an invaluable, empirically supported, practical, and flexible alternative. All practicing psychotherapists need to be familiar with it." --A. Thomas Horvath, PhD, FAClinP, President, Practical Recovery Services, La Jolla, California
"This book provides a blueprint for therapists who wish to provide...an integrated approach to the treatment of a variety of addictive behaviors, with or without the co-occurrence of other psychological or behavioral disorders. For the first time, clients who wish to receive therapy to help them cope with an ongoing alcohol or other drug problem will not be turned away at the door by either substance abuse counselors (who insist upon abstinence as the only acceptable treatment goal) or by mental health therapists (who often refer active drug users to substance abuse treatment before they will accept them for psychotherapy)....Denning provides a trail-blazing journey into the new world of harm reduction therapy." --from the Foreword by G. Alan Marlatt, PhD, University of Washington
Review
"Denning's book has a number of strengths. It is written clearly and in sufficient detail to be accessible to a wide array of practitioners, which is important for a book whose prime audience is mental health and addiction treatment providers....Another outstanding feature of the book is its combination of discussion of research and theory with clinical case application; the latter includes extensive review of the processes that go into treatment planning, implementation, and modification based on patient responses. The book also presents views of addictive behavior and its modification that reflect current research and theory. As such, the book delivers on its promise of presenting an approach that is an alternative to the status quo in American SUDs treatment services....the first detailed account of application of an important public health model to developing a SUDs treatment approach. Accordingly, the book has much to offer to clinical practitioners and researchers who are interested in learning about treatment approaches that are alternatives to the SUDs treatment establishment in the United States."--Clinical Psychology Review
"Practicing Harm Reduction Psychotherapy: An Alternative Approach to Addictions introduces the reader to a new and innovative way to view addictions and provides a nontraditional approach to the treatment of individuals with substance abuse difficulties. The author utilizes her extensive experience in the fields of mental health and substance abuse to inform this theoretical orientation, impart practical knowledge and skills, and cause the reader to reexamine his/her beliefs concerning addictions....The use of clinical case examples and step-by-step guidelines for assessment and treatment makes it a must read for all mental health and substance abuse practitioners. Moreover, the book's extensive appendices make it a handy source of reference and an invaluable addition to one's personal library."--Canadian Journal of Counselling
"This is a great book that has radical reform implications for treating drug users and addicts....This is a very important book, providing new ways of looking at things in an area where there is a lot of pessimism. The pessimism is likely due, in large measure, to the assumptions about treatment of drug users that we currently hold, and which are just wrong, according to this book."--American Journal of Psychiatry
"...an essential tool for the modern practitioner who treats any patient using drugs. Harm Reduction is a port in the storm. But far better that the storm would end and we stopped making the life of the drug user a living hell--where the substance abuse problems are compounded with the social harms of criminalization. When that day comes, these clinical models and methods will become the standards of future practice and, I believe, will help make many of the worst drug problems we see today a thing of the past."--Addiction
"This book is highly integrative and inclusive of clinical intervention models and approaches. Denning's model is empirically and clinically supported....A highly recommended reading for all social workers, counselors, therapists, and students."--CASW Bulletin
"This well-written book presents an approach for integrating harm reduction therapy into everyday psychotherapeutic practice....This text is written primarily for general psychotherapists wishing to add substance abuse treatment to their practice. It would also be useful in training graduate students in the integration of addictions treatment into everyday clinical practice--a useful skill to possess given the high rates of addictive disorders in the general population....The author presents the material in a nonthreatening manner that allows the reader flexibility in applying aspects of this intervention to his/her own clinical work....This book provides clinicians, educators and graduate students with a practical approach to treating addictions in the context of other mental health issues. It is hoped that, having read this book, more psychotherapists will be willing to provide addictions treatment in the context of their general practice."--Journal of Studies on Alcohol
Review
"This pioneering book presents an integrated, realistic psychotherapeutic approach for individuals with substance use problems. The second edition develops the treatment model in great detail and provides a wide range of valuable harm reduction resources--for example, guidelines for combining psychotherapy with medication for patients with serious comorbidity. An excellent practical reference for general mental health practitioners and addiction specialists."--Linda Carter Sobell, PhD, ABPP, and Mark B. Sobell, PhD, ABPP, Center for Psychological Studies, Nova Southeastern University
"The substance abuse treatment community in the United States ignored this evidence-based approach for way too long. This important book shows how practitioners can treat clients at the precise point where they are capable of making changes. It features examples, case studies, and valuable information on applying harm reduction principles in group work, supervision, and other contexts, in addition to individual psychotherapy. This is a 'must read' for anyone in the field of addictive disorders."--Robert J. Meyers, PhD, Emeritus Research Associate Professor of Psychology, University of New Mexico; Director, Robert J. Meyers, PhD, and Associates
"The second edition of Practicing Harm Reduction Psychotherapy is a book whose time has come. Harm reduction is finally recognized as a basic concept that needs to inform the treatment of all clients with substance use problems, particularly those who have co-occurring disorders. Denning and Little clearly position harm reduction as a current, integrated, nondogmatic, client-centered treatment approach."--Shulamith Lala Ashenberg Straussner, DSW, LCSW, Silver School of Social Work, New York University
"Denning and Little have earned an international reputation for their research and clinical practice. Highlighting the principle of 'doing patients no harm,' the authors explain the theoretical background of harm reduction psychotherapy and describe how to conduct it. The book is packed with vivid, intriguing examples. I recommend it to a broad readership of mental health professionals and students."--Hendrik G. Roozen, PhD, Novadic-Kentron Treatment Services and Erasmus University Medical Center, The Netherlands
Review
"This is a great book that has radical reform implications for treating drug users."--American Journal of Psychiatry
Review
"This well-written book....[would be] useful in training graduate students in the integration of addictions treatment into everyday clinical practice—a useful skill to possess given the high rates of addictive disorders in the general population."--Journal of Studies on Alcohol
Review
"Accessible to a wide array of practitioners....[Combines] discussion of research and theory with clinical case application....The book delivers on its promise of presenting an approach that is an alternative to the status quo in American SUDs treatment services."--Clinical Psychology Review
Review
"An essential tool for the modern practitioner who treats any patient using drugs."--Addiction
Review
"The real strength in this book lies in its optimism that it is possible to treat 'extremely damaged individuals'...the principle of excluding no-one from treatment is most welcome."--Alcohol and Alcoholism
Review
"Introduces the reader to a new and innovative way to view addictions and provides a nontraditional approach to the treatment of individuals with substance abuse difficulties....A must read for all mental health and substance abuse practitioners."--Canadian Journal of Counselling
Synopsis
Demonstrating that traditional approaches to addictions fall short for many substance abusers with psychological problems, this book shows how effective therapeutic work can be conducted with clients still using alcohol or other drugs. For the first time, the goals and methods of harm reduction are incorporated into a comprehensive psychotherapeutic approach--one that can be initiated without waiting for, or insisting on, abstinence. Clinicians learn concrete strategies for assessing the client's personality, behaviors, and resources; enhancing motivation for change; making collaborative treatment decisions; and implementing a range of different interventions.
Synopsis
This acclaimed clinical guide, now substantially revised and updated, has helped thousands of clinicians put the proven principles of harm reduction into practice with therapy clients who have substance use problems. Written by pioneers in the field, the book shows how to do effective therapeutic work with people still using alcohol or other drugs. It provides clear guidelines for conducting comprehensive assessments, making collaborative treatment decisions, and implementing interventions that combine motivational, cognitive-behavioral, and psychodynamic strategies. The focus is reducing drug-related harm while also addressing co-occurring psychological and emotional difficulties. Detailed clinical illustrations are featured throughout.
New to This Edition
*Reflects over a decade of research advances and the tremendous growth of harm reduction clinical practice and training.
*Section on applications, with chapters on community-based settings, harm reduction groups, and working with families and friends.
*Chapters on biological and psychodynamic aspects of treatment.
*Expanded discussions of trauma, cultural sensitivity, and ethics.
*Supplemental resources and training information at the authors' website: www.harmreductiontherapy.org.
About the Author
Patt Denning, PhD, one of the primary developers of harm reduction psychotherapy, is Director of Clinical Services and Training at the Harm Reduction Therapy Center (HRTC) in San Francisco, which she founded with Jeannie Little in 2000. HRTC provides a full range of mental health services to dually diagnosed individuals and trains hundreds of professionals each year. Dr. Denning has worked in community mental health and private practice since 1975, specializing in differential diagnosis, psychopharmacology, psychotherapy with seriously disturbed patients, HIV, and substance use disorders. She is a Diplomate Fellow in psychopharmacology and a certified addiction specialist through the American Psychological Association's College of Professional Psychology. Jeannie Little, LCSW, is Executive Director of HRTC. Since 1994, Ms. Little has developed harm reduction treatment services for multidiagnosed clients, beginning at Healthcare for Homeless Veterans and then in private practice and at HRTC. A certified group psychotherapist, she specializes in group treatment of substance use disorders and dual diagnosis. Ms. Little is a trainer in the areas of dual diagnosis, group treatment, and professional development of staff who work in a variety of social service and housing settings. She is coauthor, with Patt Denning and Adina Glickman, of a book for the general public,
Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol.
Table of Contents
Contents
I. Overview of Harm Reduction Psychotherapy
1. What Is Harm Reduction?
Introduction: First, Do No Harm
The Principles of Harm Reduction Psychotherapy
The Moral Question: Is it Ok to Get High?
Epidemiology: Who Are These People?
The Nature of Success Redefined
2. The Development of Harm Reduction Psychotherapy
The Basic Models and Viewpoints on Addiction
Discussion of the Principles of Harm Reduction Psychotherapy
Case Illustration
Discussion of the Model
II. Harm Reduction Psychotherapy in Action
3. The Treatment Program: Assessment as Treatment
Introduction to the Multidisciplinary Assessment Profile
Motivational Interviewing
The Multidisciplinary Assessment Profile
Conclusions
4. Treatment Design: How to Think about a Case
The Foundations of Treatment Treatment Matching
Essential Concepts in Treatment
The Contributions of Neurobiology
5. Clinical Cases Using Harm Reduction Psychotherapy
The Case of Joan (Continued)
Speed and Sex: The Case of Dan
Self-Esteem, Motivation, and Crack: The Case of Angie
Lost in America: The Case of Zeke
Between Two Worlds: The Case of Bhati
Conclusions
6. Dual- and Multidiagnosis Patients
Comorbidity
Differential Diagnosis by Type of Drug
Differential Diagnosis by Psychiatric Disorder
A Hierarchy of Needs with Dual-Diagnosis Patients
Medication Strategies for Dual-Diagnosis Patients
Multidiagnosis Patients: The Case of Steve
Summary and Conclusions
III. Integrating the New with the Old
7. Harm Reduction Psychotherapy: Applications and Adjustments
The AIDS Housing Project
Grand Rounds Clinical Case Conference
The Difficulties of Combining Models and Techniques
The Cost of Treatment and the Need for Self-Help Groups
Ethical Considerations and Informed Consent
Appendices
Appendix A: Overview of Psychoactive Drugs:
Alcohol
Depressants (Opioids)
Depressants (Nonopioids)
Stimulants
Anxiolytics
Cannabinoids
Highlighters/Scramblers (Psychedelics and Amphetamine Pychedelics)
Inhalants and Deliriants (Solvents, Anesthetics, Vasodilators)
Appendix B References for Specific Drug Effects
Appendix C History of Drugs and Attitudes toward Them:
Alcohol in the United States
Other Drugs
Appendix D Self-Help Reading List
Appendix E Alternative Self-Help and Professional Resources
Appendix F Specific Treatment Modalities/Techniques:
Cognitive-Behavioral
Psychodynamic Psychotherapies
Self-Help Models