Bill Shankly, the legendary manager of Liverpool Football Club once said:

‘Some people believe football is a matter of life and death. I’m very disappointed with that attitude. I can assure you it is much, much more important than that.’

Andrew Tatarsky, the editor of this volume claims that this book describes “Harm Reduction Psychotherapy, a new treatment for drug and alcohol problems.” I can assure you it is much, much more important than that.

Well, why would I be saying that, then? Here we have no more than a collection of case reports on people with alcohol and/or illicit drug problems who have engaged with a number of psychotherapists in the USA. There is also one rather out of place chapter on sobriety support group work with dually diagnosed folk. The processes that the nine individual clients have gone through during their therapy are described in great detail and some of the accounts are so vivid that the patients/clients literally leap out of the book to meet you, because you’ve met their sort before. That is all as one would expect from a good psychotherapy book. And one might also expect some sort of commentary on the cases to be provided by the editor: why this was a particularly interesting case, an object lesson for others in the field. That is all there too. So what’s new – what is this “new treatment for drug and alcohol problems”? What’s new is that these are case studies from the USA where the goal of abstinence and dutiful adherence to the disease concept and 12-step approaches to therapy are not observed.

These are case studies where the therapists were willing to do something quite brave in the USA. They were willing to work with actively drinking and/or drug taking clients; they were willing to negotiate treatment goals; they were willing to talk with people who were intoxicated and they were, most notably, willing to “hang on in there” and live with the substance related ups and downs of their clients’ lives. And yet, and yet, I suspect that there is nothing that unusual about these stories. I suspect that these kinds of interventions are being practised covertly in therapy rooms all over the States. So that wasn’t what was brave. What was brave was that these psychotherapists were willing to stand up and be counted. They were willing to put themselves in print, to talk about what they did, or thought they did, with these clients. And they did so, I assume, because Andrew Tatarsky had convinced them that what they were doing could be defended from a hostile response from 12 step fundamentalists by being labelled “harm reduction”.

Continued at http://www.erowid.org/references/refs_view.php?ID=6935