Harm reduction therapy was originally developed as a nonabstinence-based method of treating people with drug and alcohol problems. In this article, we describe and apply the principles and practices of harm reduction therapy in community settings, places where people congregate for nontherapeutic reasons-street corners, community drop-in centers, needle exchanges, and primary care clinics. Low-threshold welcome and flexible session arrangements are defining characteristics of this community-based approach. We have been instrumental in developing several programs, three of which are described here. These programs work with more than 1,000 clients per year, with varying levels of intensity. The programs offer drop-in or sidewalk sessions, drop-in support groups, regular therapy appointments, and psychiatric medications. Many impressive outcomes, such as reduction of harmful drug use, stabilization of psychiatric problems, and permanent housing, are found each year.
One of the first examples of this descriptive trend was the Epidemiological Catchment Area Study (ECA). Initiated to assess the rates of psychiatric disorders in community and institutionalized samples, the ECA found that 22.3% of those with a lifetime mental disorder diagnosis had a lifetime history of alcohol abuse-dependence, whereas 15.0% reported a lifetime comorbid drug abuse-dependence disorder. The rates of co-occurrence/comorbidity or dual diagnosis rise considerably when viewed from the base rates of substance use. Thirty-seven percent of those with a lifetime diagnosis of alcohol abusedependence have a co-occurring mental disorder, whereas 53.1% of individuals with a lifetime drug disorder report a comorbid mental disorder. The rates are even higher among the institutionalized ECA sample, similar to the prevalence of substance use and dual
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.