Therapeutic interventions for individuals with substance use, HIV, and personality disorders: Harm reduction as a unifying approach

This article presents a discussion and case illustration of using harm reduction as a model for treatment design for individuals presenting with multiple problems. Initial difficulties with engagement into treatment are discussed, as well as early strategies based on easing intake requirements and responding quickly to clients' stated needs. Some of these strategies include developing a needs hierarchy that clients participate in, not setting fixed rules for their behavior regarding their drug use, and a willingness to work with them on other pressing problems, such as housing despite active drug use. This strategy results in a working alliance based on mutual, honest exploration of clients' problems and creative solutions to them. In the case presented, shifting symptoms were addressed often without a diagnosis that could clarify whether the cause of the symptom was psychiatric, substance abuse, or medical in origin. Treatment team recommendations are given. © 1998 John Wiley & Sons, Inc.