Harm Reduction Treatment for Substance Use

Susan E. Collins, PhD, is a licensed clinical psychologist, faculty at the University of Washington School of Medicine and Washington State University, and co-director of the Harm Reduction Research and Treatment (HaRRT) Center. Dr. Collins has been involved in substance use research, assessment, and treatment for over 25 years and has disseminated this work in more than 80 book chapters, abstracts, and peer-reviewed articles. Dr. Collins also brings her own lived experience as a person in recovery from addictive behaviors and as a woman embedded in families with the intergenerational experience of substance use disorder and harm.Seema L. Clifasefi, PhD, MSW, is an associate professor and co-director of the Harm Reduction Research and Treatment (HaRRT) Center at the University of Washington-Harborview Medical Center. Her research lies at the intersection of substance use, mental health, criminal justice, and housing policy. For the past nearly two decades she has been part of several collaborative academic/community-based research partnerships focused on the development and evaluation of individual and community-level harm reduction programs and interventions designed for and with people who have lived experience of homelessness and substance use problems.

• AcknowledgmentsPreface1 Description1.1 Terminology and Definitions1.1.1 Harm Reduction Heartset as Foundation1.1.2 Harm Reduction Mindset as Pragmatic1.1.3 Harm Reduction Applied at VariousSystems Levels1.2 Applying Harm Reduction in Clinical Work1.2.1 Accepting Substance Use Is Here toStay1.2.2 Important Reasons for AcknowledgingClients Use1.2.3 Recognizing Substance-RelatedHarm Is Shaped by Systems1.2.4 Supporting Clients' Own Steps TowardHarm Reduction1.2.5 Working Toward Social Justice andRacial Equity1.3 Clinicians' Rationale for Harm Reduction .1.3.1 Abstinence-Only Approaches AreDisempowering1.3.2 Abstinence-Based Approaches DoNot Optimize Engagement1.3.3 Harm Reduction Approaches AreEffective1.4 The Harm Reduction Treatment Model1.5 Related and Foundational TreatmentModels1.5.1 "Controlled Drinking"1.5.2 Brief Interventions in Health CareSettings1.5.3 Personalized Normative FeedbackInterventions1.5.4 Motivational Interviewing1.5.5 Guided Self-Change1.5.6 Harm Reduction Psychotherapy1.6 Conclusions2 Theories and Models Informing HaRT2.1 Pharmacological Treatment for HaRT2.2 Behavioral Harm Reduction TreatmentTheory2.2.1 HaRT Mindset2.2.2 HaRT Heartset2.2.3 HaRT Components2.3 What HaRT Is Not3 Assessment and Treatment Indications3.1 Treatment Indication3.2 Indication and Preparation for HaRT3.2.1 Reflecting On and Preparing YourPractice Setting3.2.2 Preparing to Navigate Systems Forand With Clients3.3 Assessment of HaRT Efficacy on KeyOutcomes3.3.1 Assessment of Safer-Use Strategiesand Harm Reduction Goal Setting3.3.2 Assessment of Substance Use Outcomes3.3.3 Lab Testing and Biomarkers3.3.4 Measures of QoL Outcomes3.3.5 Measures for Utilization and CostAnalysis3.3.6 Treatment Integrity Materials andMeasures4 HaRT Implementation4.1 Method of Approach4.1.1 HaRT Mindset4.1.2 HaRT Heartset4.1.3 HaRT Components and Their Integrationin Initial and Follow-Up Sessions4.2 HaRT Efficacy and Prognosis4.2.1 Behavioral Harm Reduction Treatmentfor AUD4.2.2 Combined Pharmacotherapy andBehavioral Treatment4.3 Variations and Combined Treatments4.3.1 Auxiliary HaRT Components4.4 Problems in Carrying Out the Approaches4.5 Diversity Issues5 Case Vignettes6 Further Reading7 References8 Appendix: Tools and Resources