Treating the resistant substance abuser: Harm reduction (re)emerges as sound clinical practice

The traditional medical model of treatment for substance abuse has worked for some addicts. However, many have been unable to benefit from this paradigm because of comorbid psychiatric disorders that are not addressed, or due to individual characteristics or preferences that are not considered by the unitary approach of medical model treatment. A harm reduction approach, which combines principles of psychotherapy with substance use treatment, is described and illustrated with a case example of a woman treated for alcoholism and depression. This approach is nonauthoritarian, collaborative, and based on an integration of psychodynamic, cognitive-behavioral, and substance use treatment techniques. © 1998 John Wiley & Sons, Inc.