Harm Reduction Therapy for Co-occurring Disorders

Britt K. Anderson, Alan Marlatt, Ph.D. , George A. Parks, Ph.D., Ph.D., G.

What is Harm Reduction Therapy?

Harm reduction therapy was initiated as a public health policy to fix the struggles of people who couldn’t avoid consuming drugs, as per the Journal of Paediatrics & Child Health. According to the National Institute on Drug Abuse  (NIDA), drug addiction is a chronic condition with relapse rates of 40 to 60 percent. For certain people, total abstinence isn’t essential. As a result, harm reduction offers services to those who are in need while also decreasing the stigma and consequences of substance use and abuse in a nondiscriminatory manner.

The following can be achieved with harm reduction therapy

• Reduce the fatality rate from overdoses.
• Minimizes the likelihood of contracting a blood-borne illness.
• Criminal activities relating to substance addiction are restricted.
• Assists in reducing overall drug usage.

Harm reduction strategies are divisive since they don’t seem to require participants to abstain from using all drugs. Many people assume that the best way to heal is to refrain entirely. Harm reduction therapy initiatives, strategies, and procedures, on the other hand, are cost-effective. They positively impact neighborhoods and are evidence-based initiatives that follow Harm Reduction International’s guidelines.

Psychological Practice and Co-Occurring Disorders

Harm reduction therapy is a general concept that applies to strategies that seek to minimize the negative impact of actions (Marlatt, 1998). The word “harm reduction” is most often associated with excessive addiction, but it may also refer to harmful behaviour. At one end of the continuum, harm reduction will facilitate safe injection services to reduce the risk of disease transmission. To reduce alcohol poisoning risk, harm reduction measures should prioritize less unhealthy drinking habits for adolescent college students.

Encourage safe sex, offer nutritious food instead of binge eating, supply clean razors to all those who injure themselves or self-harm, and even recommend 5 minutes of activity per day are only a few of the suggestions. Every meaningful change is inextricably related to harm reduction. Harm reduction opponents may dispute that it aids or excuses terrible decisions somehow. Though abstinence is now the most successful way to mitigate the harm caused by drug misuse, harm reduction practitioners help the client regardless of where they stand on the matter of change. Psychoactive substance addiction is the most common symptom of Axis I disorders.

Furthermore, drug and alcohol disorders are often comorbid with other mental conditions, rendering adequate diagnosis and treatment almost tricky. Dual diagnosis, Mentally Ill Chemical Abuser (MICA), dual disorders, and other words describe axis I and II psychological diseases and mental illnesses that co-occur alongside psychoactive substance use disorders. Regardless of the lack of a universally accepted term, co-occurring conditions refer to mental illnesses and drugs that occur together. Since co-occurring diseases are becoming more common and impact many people’s health and well-being, it is essential to assess a more successful treatment.

Owing to a shortage of funding, the service delivery system is inadequate to support people with existing disabilities (Roberts and Marlatt, 1998). Denial of medication or treatment for alcoholism can only occur in substance abuse services with high admission requirements for treatment. When clients present with existing conditions, they may only receive mental health care from a therapist who doesn’t feel they are qualified to handle substance or alcohol issues. Despite reliable medical evaluations and diagnosis, co-occurring diseases are often treated one after the other in the hopes of addressing one before treating the other.

When multiple conditions are handled simultaneously, separate providers are usually treated, with the individual bearing the patient care responsibility. Worse, a prospective client could become the object of stiff competition among providers to see who can offer the best care or diagnosis and which solution is more technically reliable. For all those dependent on or abusing illegal substances, drugs’ criminalization presents an obstacle to recovery. Recently, there has been a lot of progress in co-occurring disorders. Psychologists must strive to create, disseminate, review, and incorporate these comprehensive therapeutic approaches.

Co-occurring conditions are becoming more prevalent, posing an increasing concern to our client’s health, necessitating the creation of more successful therapies.

Preventing Relapse and Reducing Damage

Relapse prevention counselling (RPC) and cognitive-behavioural therapies (CBT) are beneficial treatments regarding addictive habits in some trials (Bowers, Irvin, Wang & Dunn, 1999). Harm reduction therapy, and the moral philosophy embedded throughout the war against drugs, has recently been developed as an alternative to conventional abstinence-based drug rehabilitation. RPC can recognize that therapeutic progress is achieved in small steps or stages of transformation. They offer care to devoted users independent of the therapy’s end goal (moderation or abstinence) ( DiClemente & Prochaska, 1992).

Relapse Prevention Counselling (RPC)

Relapse Prevention Counselling (RPC) teaches people cognitive-behavioural techniques to help them stay free of addiction. RPC comprises two interconnected components: 1) relapse control, which enables clients to reduce the severity, extent, and negative repercussions of any mistakes that might occur; and 2) relapse avoidance, which allows clients to predict and prevent an initial lapse or slip. Relapse prevention counsellors empower clients to continue the habit-changing phase after a reversal by stressing that creating new behaviours requires both losses and gains.

Recently, RPC programs for co-occurring conditions were launched ( Shaner, Roberts, & Eckman, 1999). Managing skills training is the foundation of RPT, and it teaches clients how to: a) identify and cope effectively with high-risk circumstances, b) acknowledge relapse as a process, c) implement harm control strategies during a lapse to minimize its detrimental consequences, and d) manage urges and cravings, in order to remain committed to caring about relapse and to find out how to live a more healthy life. RPC’s efficacy as a psychosocial remedy for alcohol and opioid disorders has been confirmed by ongoing treatment outcome studies (Irvin et al., 1999).

Harm Reduction Therapy (HRT)

The concept of harm reduction therapy has been around for over a century. It encourages people with co-occurring mental and physical disabilities to be as caring as they can be. Rather than referring active substance abusers with mental health issues towards treatment, harm reduction professionals meet consumers at “their level,” making sure to consider their willingness to alter and attempting to reduce the amount of harm each of the causes of their problems.HRT aims to improve a user’s overall mental health and well-being while still focusing on alcohol and drug abstinence, withdrawal, or moderation. In consideration of harm reduction, maladaptive behaviours may also be positioned on a scale of detrimental effects.

HRT seeks to assist clients in moving down this spectrum toward a lower risk of damage. Any positive step is a step forward, and backsliding and lapses are expected as part of the development process. The strategies and tactics of HRT are focused on both a global policy and an interdisciplinary care approach. Acting medically with people or organizations, changing the setting, and improving public policies are the fundamental methods of harm reduction. This strategy allows for limited access to public services since it removes possible obstacles to client involvement and does not impose pre-conditions for care admission.

The practitioners of harm reduction therapy believe that by embracing a constructive approach, they can help remove the stigma and guilt involved in seeking help for such issues. They offer a comprehensive and holistic treatment method that treats co-occurring drug use and psychological issues in the same way as any other behavioural health issue. Goal-setting and treatment preparation in HRT are joint efforts. The therapist offers input, guidance, encouragement, and coping education and training, personalized to the improvements the individual seeks.

The harm reduction therapists are aware of the patient’s skill deficits and motivational state and use a strategic mix of motivational development and skills improvement strategies to help them (Kivlahan, Baer, & Donovan, 1999). Furthermore, because of its adaptability, HRT is suitable for treating patients who are hard to work with medically because of missed visits, negligence with treatment, or a lack of desire to improve. Harm reduction therapists work to enhance a client’s problem behaviours to deter more harmful outcomes. In this situation, the doctor’s task is to implement a relapse prevention strategy to enhance progress stabilization and avoid the problem from deteriorating.

Alongside the resolution of all problematic behaviours, HRT’s next goal is to help clients steadily reduce the negative consequences the patients are experiencing, ranging from simple reductions in danger and harm to the complete cessation of such behavioural problems. Therapists working in an HRT environment must be able to offer evidence-based therapies for addictive addiction. Since it focuses on understanding principles, coping skill development, and a behaviour change continuum model, CBT (cognitive-behavioural therapy) is particularly well suited to this approach ( Tebbutt, Jarvis, & Mattick, 1995).

Harm reduction clinicians need “client-centred” approaches like Motivational Enhancement Therapy (MET), which also focuses on developing a viable therapeutic relationship, responding successfully to opposition to reform, and fostering ongoing encouragement ( Rollnick & Miller,1991). HRT, which combines both skill training practices and emotional enhancement by an accepting therapist, can help users maintain their trust over time and learn how to make the changes they want. The best HRT treatments for opioid addiction include methadone for treating patients who use heroin and naltrexone for treating patients who abuse alcohol and nicotine replacement therapy for smokers who drastically cut or stop smoking. Irrespective of the techniques used, HRT facilitates an open and inclusive therapeutic relationship. Harm reduction practitioners solicit input from their clients daily.

Unlike several other services for opioid addiction, alcoholism, and mental illness, HRT does not set rehabilitation goals or administer treatments without the client’s permission. Harm Reduction Therapy, in general, combines science and therapeutic practise, allowing psychology to “come back to our core responsibility to treat all clients as particular people instead of labels and diagnoses…(thereby)…assisting them in seeking their remedies, regardless of the underlying problem that causes their discomfort.” Hence Harm Reduction Therapy is important.

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