Skip to main content

Advertisement

SpringerLink
Log in

Starting Where the Client Is: Harm Reduction Guidelines for Clinical Social Work Practice

  • Original Paper
  • Published:
Clinical Social Work Journal Aims and scope Submit manuscript

Abstract

Harm reduction has gradually entered social work discourse and is now seen as a promising approach for treating individuals with drug and alcohol problems. However, beyond statements and data supporting the utility of a harm reduction approach, few guidelines for clinical practice have been detailed in the social work literature. This lack of concrete detail regarding how harm reduction is actually practiced limits the potential implementation of the model into day-to-day clinical work. This article reiterates that harm reduction is a viable approach to clinical social work practice with individuals who have drug- and alcohol-related problems and for whom traditional approaches may be inappropriate. It focuses on harm reduction therapy as an emerging treatment model that can be implemented by clinical social workers and mental-health and substance use treatment providers. The article identifies and elaborates several basic tenets that can be incorporated into clinical social work. It is hoped that social workers who learn how harm reduction is implemented in clinical practice will be more apt to incorporate its principles into their work.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Anderson, K. (2010). How to change your drinking: A harm reduction guide to alcohol (2nd ed.). New York: HAMS Harm Reduction Network.

    Google Scholar 

  • Anthony, J. C., Warner, L. A., & Kessler, R. C. (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology, 2, 244–268.

    Article  Google Scholar 

  • Bigg, D. (2001). Substance use management. Journal of Psychoactive Drugs, 33(1), 33–38.

    Article  PubMed  Google Scholar 

  • Bigler, M. O. (2005). Harm reduction as a practice and prevention model for social work. Journal of Baccalaureate Social Work, 10(2), 69–86.

    Google Scholar 

  • Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. London: Routledge.

    Google Scholar 

  • Brocato, J., & Wagner, E. F. (2003). Harm reduction: A social work practice model and social justice agenda. Health Social Work, 28, 117–125.

    Article  PubMed  Google Scholar 

  • Coulson, C., Ng, F., Geertsema, M., Dodd, S., & Berk, M. (2009). Client-reported reasons for non-engagement in drug and alcohol treatment. Drug and Alcohol Review, 28, 372–378. doi:10.1111/j.1465-3362.2009.00054.x.

    Article  PubMed  Google Scholar 

  • Center for Harm Reduction Therapy. (2016). How you can help. Retrieved from http://harmreductiontherapy.org/helping-opportunities/.

  • Davis, D., Hawk, M., Marx, M., & Hunsaker, A. (2014). Mechanisms of adherence in a harm reduction housing program. Journal of Social Work Practice in the Addictions, 14(2), 155–174. doi:10.1080/1533256X.2014.902702.

    Article  Google Scholar 

  • Davis, A. K., & Rosenberg, H. (2013). Acceptance of non-abstinence goals by addiction professionals in the United States. Psychology of Addictive Behaviors, 27(4), 1102–1109. doi:10.1037/a0030563.

    Article  PubMed  Google Scholar 

  • Denning, P. (1998). Therapeutic interventions for people with substance abuse, HIV, and personality disorders: Harm reduction as a unifying approach. In Session Psychotherapy in Practice, 4(1), 37–52.

    Article  Google Scholar 

  • Denning, P. (2000). Practicing harm reduction psychotherapy: An alternative approach to addiction. New York, NY: Guilford Press.

    Google Scholar 

  • Denning, P. (2001). Strategies for implementation of harm reduction in treatment settings. Journal of Psychoactive Drugs, 33(1), 23–26. doi:10.1080/02791072.2001.10400464.

    Article  PubMed  Google Scholar 

  • Denning, P., & Little, J. (2012). Practicing harm reduction psychotherapy: An alternative approach to addiction (2nd ed.). New York, NY: Guilford Press.

    Google Scholar 

  • Denning, P., Little, J., & Glickman, A. (2004). Over the influence: The harm reduction guide for managing drugs and alcohol. New York, NY: Guilford.

    Google Scholar 

  • Felitti, V. J. (2003). The origins of addiction: Evidence from the adverse childhood experiences study. (Published in Germany as “Ursprünge des Suchtverhaltens: Evidenzen aus einer Studie zu belastenden Kindheitserfahrungen.”) Praxis der Kinderpsychologie und Kinderpsychiatrie, 52, 547–559. English version: http://www.acestudy.org/files/OriginsofAddiction.pdf.

  • Fisher, J. (1999). The work of stabilization in trauma treatment. Retrieved from www.janinafisher.com/resources.php.

  • Harm Reduction Coalition (2011). Guide to developing and managing syringe access programs. Retrieved from http://harmreduction.org/issues/syringe-access/tools-best-practices/manuals-and-best-practice-documents/syringe-access-manual/.

  • Henwood, B. F., Padgett, D. K., & Tiderington, E. (2014). Provider views of harm reduction versus abstinence policies within homeless services for dually diagnosed adults. Journal of Behavioral Health Services and Research, 41, 80–89. doi:10.1007/s11414-013-9318-2.

    Article  PubMed  Google Scholar 

  • Howard, J. (2008). Negotiating an exit: Existential, interactional, and cultural obstacles to disorder disidentification. Social Psychology Quarterly, 71, 177–192.

    Article  Google Scholar 

  • Jewish Currents (2011). Interview with Ethan Nadelmann, Executive Director of Drug Policy Alliance. Retrieved from http://jewishcurrents.org/megaphone-ethan-nadelman-drug-policy-alliance-6131.

  • Karoll, B. R. (2010). Applying social work approaches, harm reduction, and practice wisdom to better serve those alcohol and drug use disorders. Journal of Social Work, 10(3), 263–281. doi:10.1177/1468017310363635.

    Article  Google Scholar 

  • Kelly, A. E., & Yuan, K.-H. (2009). Clients’ secret keeping and the working alliance in adult outpatient therapy. Psychotherapy Theory, 46(2), 193–202. doi:10.1037/a0016084.

    Article  Google Scholar 

  • Khantzian, E., Halliday, K. S., & McAuliffe, W. E. (1990). Addiction and the vulnerable self: Modified dynamic group therapy for substance abusers. New York, NY: Guilford Press.

    Google Scholar 

  • Lee, H. S., Engstrom, M., & Petersen, S. R. (2011). Harm reduction and 12 steps: Complementary, oppositional, or something in-between? Substance Use and Misuse, 46(9), 1151–1161.

    Article  PubMed  Google Scholar 

  • Little, J. (2001). Treatment of dually diagnosed clients. Journal of Psychoactive Drugs, 33(1), 27–31.

    Article  PubMed  Google Scholar 

  • Little, J. (2006). Harm reduction therapy groups: Engaging drinkers and drug users in a process of change. Journal of Groups in Addiction and Recovery, 1, 69–94.

    Article  Google Scholar 

  • Little, J. (2015). What’s under the harm reduction umbrella? Part one. The Fix. Retrieved June 28, 2015 from http://www.thefix.com/content/ under-harm-reduction-therapy-umbrella-part-1.

  • Little, J., & Franskoviak, P. (2010). We’re glad you came: Harm reduction therapy in community settings. Journal of Clinical Psychotherapy. In Session, 66(2), 175–188.

    Google Scholar 

  • Little, J., Hodari, K., Lavender, J., & Berg, A. (2008). Come as you are: Harm reduction drop-in groups for multi-diagnosed drug users. Journal of Groups in Addiction and Recovery, 3, 161–192.

    Article  Google Scholar 

  • Lushin, V., & Anastas, J. W. (2011). Harm reduction in substance abuse treatment: Pragmatism as an epistemology for social work practice. Journal of Social Work Practice in the Addictions, 11(1), 96–100. doi:10.1080/1533256X.2011.546205.

    Article  Google Scholar 

  • Lower East Side Harm Reduction Center. (2014). Our funders. Retrieved from http://www.leshrc.org/page/our-funders.

  • Macmaster, S. A. (2004). Harm reduction: A new perspective on substance abuse services. Social Work, 49, 356–363.

    Article  PubMed  Google Scholar 

  • Magidson, J. F., Young, K. C., & Lejuez, C. W. (2014). A how-to guide for conducting a functional analysis: Behavioral principles and clinical application. The Behavior Therapist, 37(1), 4–12.

    Google Scholar 

  • Mancini, M. A., Linhorst, D. M., Broderick, F., & Bayliff, S. (2008). Challenges to implementing the harm reduction approach. Journal of Social Work Practice in the Addictions, 8(3), 380–408. doi:10.1080/15332560802224576.

    Article  Google Scholar 

  • Marlatt, G. A. (Ed.). (1998). Harm reduction: Pragmatic strategies for managing high-risk behaviors. New York: Guilford Press.

    Google Scholar 

  • Marlatt, G. A., & Gordon, J. (Eds.). (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.

    Google Scholar 

  • McIntosh, J., & McKeganey, N. (2000). Addicts’ narratives of recovery from drug use: Constructing a non-addict identity. Social Science and Medicine, 50, 1501–1510.

    Article  PubMed  Google Scholar 

  • Miller, W. R. (2006). Motivational factors in addictive behaviors. In W. R. Miller & K. M. Carroll (Eds.), Rethinking substance abuse: What the science shows, and what we should do about it. New York: Guilford.

    Google Scholar 

  • Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press.

    Google Scholar 

  • Najavits, L. M. (2004). Assessment of trauma, PTSD, and substance use disorder: A practical guide. In J. P. Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (2nd ed., pp. 466–491). New York: Guilford Press.

    Google Scholar 

  • National Association of Social Workers (NASW). (2012). Alcohol, tobacco, and other drugs. Social work speaks: National Association of Social Workers policy statements, 2012–2014 (pp. 28–33). Washington, DC: Author.

    Google Scholar 

  • National Association of Social Workers (NASW). (2013a). National standards for social work practice with clients with substance use disorders. Washington, DC: Author.

    Google Scholar 

  • National Association of Social Workers (NASW). (2013b). A social work perspective on drug policy reform: Public health approach. Washington, DC: Author.

    Google Scholar 

  • National Institutes of Drug Abuse. (2014). Drug facts: Heroin. https://www.drugabuse.gov/publications/drugfacts/heroin. Accessed 16 Feb 2016.

  • Palmer, R. S., Murphy, M. K., Piselli, A., & Ball, S. A. (2009). Substance user treatment dropout from client and clinical perspectives: A pilot study. Substance Use and Misuse, 44, 1021–1038. doi:10.1080/10826080802495237.

    Article  PubMed  PubMed Central  Google Scholar 

  • Patel, A. B. & Fromme, K. (2014). Expectancies and their influence on drug effects. In Encyclopedia of psychopharmacology (pp. 1–5). Retrieved from http://link.springer.com/referenceworkentry/10.1007%2F978-3-642-27772-6_174-2.

  • Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47, 1102–1114.

    Article  PubMed  Google Scholar 

  • Reid, R. J. (2002). Harm reduction and injection drug use: Pragmatic lessons from a public health model. Health and Social Work, 27(3), 223–226.

    Article  PubMed  Google Scholar 

  • Rothschild, D. (2010). Partners in treatment: Relational psychoanalysis and harm reduction therapy. Journal of Clinical Psychology, 66(2), 136–149.

    PubMed  Google Scholar 

  • Rothschild, D. (2015). The “third wave” of substance use treatment. The Fix. Retrieved from http://www.thefix.com/content/third-wave-substance-use-treatment.

  • Ryan, R., & Deci, E. (2000). Self determination theory and the facilitation of intrinsic motivation, social development and well-being. American Psychologist, 55, 68–78.

    Article  PubMed  Google Scholar 

  • Seiger, B. H. (2003). Harm reduction: Is it for you? Journal of Social Work Practice in the Addictions, 3(3), 119–121. doi:10.1300/J160v03n03_09.

    Article  Google Scholar 

  • Springer, E. (1991). Effective AIDS prevention with active drug users: The harm reduction model. Journal of Chemical Dependency Treatment, 4, 141–157.

    Article  Google Scholar 

  • Straussner, S. L. (2012). Clinical treatment of substance abusers: Past, present, and future. Clinical Social Work Journal, 40, 127–133. doi:10.1007/s10615-012-0387-0.

    Article  Google Scholar 

  • Substance Abuse and Mental Health Services Administration (2013). SAMHSA’s working definition of recovery: 10 guiding principles. Retrieved from http://store.samhsa.gov/shin/content/PEP12-RECDEF/PEP12-RECDEF.pdf.

  • Substance Abuse and Mental Health Services Administration (2014). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: Author.

  • Tatarsky, A. (1998). An integrated approach to harm reduction psychotherapy: A case of problem drinking secondary to depression. In Session Psychotherapy in Practice, 4(1), 9–24.

    Article  Google Scholar 

  • Tatarsky, A. (2002). Harm reduction psychotherapy: A new treatment for drug and alcohol problems. Northvale, NJ: Jason Aronson.

    Google Scholar 

  • Tatarsky, A. (2003). Harm reduction psychotherapy: Extending the reach of traditional substance use treatment. Journal of Substance Abuse Treatment, 25, 249–256. doi:10.1016/S0740-5472(03)00085-0.

    Article  PubMed  Google Scholar 

  • Tucker, J. A., & Simpson, C. A. (2011). The recovery spectrum: From self-change to seeking treatment. Alcohol Research and Health, 33(4), 371–379.

    PubMed  PubMed Central  Google Scholar 

  • van Wormer, K. (2004). Harm reduction. Social Policy Journal, 3, 19–37.

    Google Scholar 

  • Witkiewitz, K. (2005). Defining relapse from a harm reduction perspective. Journal of Evidence-Based Social Work, 2(1–2), 191–206. doi:10.1300/J394v02n01_11.

    Article  Google Scholar 

  • Zinberg, N. (1984). Drug, set, setting: The basis for controlled intoxicant use. New Haven, CT: Yale University Press.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Social Work Department, Long Island University – Brooklyn, 1 University Plaza, Brooklyn, NY, 11201, USA

    Sheila P. Vakharia

  2. The Center for Harm Reduction Therapy, 45 Franklin Street, Suite 320, San Francisco, CA, 94102, USA

    Jeannie Little

Authors
  1. Sheila P. Vakharia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeannie Little
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sheila P. Vakharia.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vakharia, S.P., Little, J. Starting Where the Client Is: Harm Reduction Guidelines for Clinical Social Work Practice. Clin Soc Work J 45, 65–76 (2017). https://doi.org/10.1007/s10615-016-0584-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10615-016-0584-3

Keywords

Search

Navigation