Harm Reduction Update at Freedom Institute
In December 2023, Andrew Tatarsky, PhD, presented a Grand Rounds presentation for Silver Hill Hospital, Integrative Harm Reduction Psychotherapy: A New Paradigm for Treating Addiction. The presentation introduces Integrative Harm Reduction Psychotherapy (IHRP), a framework for effective therapy with people along the entire spectrum of risky and addictive behavior, in all stages of change and working toward all positive change goals. (View Grand Rounds here.)
In January 2024, Dr. Tatarsky joined the team at Freedom Institute, an outpatient treatment and recovery center in Manhattan, as Director of Clinical Programming. At Freedom, Dr. Tatarsky is working in close collaboration with Medical Director Ryan Wade, MD, and Director of Clinical Services Caroline Kern, LMHC, to integrate the harm reduction framework alongside the organization’s existing abstinence-based programs. The intent is to maintain the current model and continue to serve those for whom it works and is successful; as well as expand and enhance the model to include the principles of harm reduction for individuals who will progress and thrive in this approach.
Following is a Q&A with Dr. Tatarsky on the integration progress.
(More about Silver Hill Hospital and Freedom Institute here.)
Can the abstinence-based model and the harm reduction model peacefully co-exist?
It’s a common misunderstanding that abstinence and harm reduction are two different approaches. All of our services are going to be informed by harm reduction principles. The essence of the approach is that treatment is tailored to where the individual is. We’re working with people across the entire spectrum of positive change goals and motivations. Abstinence falls under this umbrella. So, yes! These models can and do peacefully co-exist.
Will individuals in different treatment models, or with different positive change goals, be in groups/programs together?
We’re going to retain the abstinence focused IOP as a program for people committed to abstinence while in treatment. By and large, it will remain as it is. Within that program, the harm reduction spirit will help individuals clarify their longer-term goals. We will also be offering a more tailored set of services that will support individual treatment plans as people consider their longer-term commitment.
Will an individual choose their “path,” or will they be guided to a path?
We will continue to meet individuals where they are and move forward together. Our approach lends itself to creating strong therapeutic alliances with people that leads to services that are in sync with their goals. It really is all about patient choice and patient collaboration. Individual’s goals evolve, become clear and clarified over time, and may change over time. We are starting where they are and sticking with them as they identify their ideal relationship with substances. For some, it’s abstinence first; for others, it’s abstinence eventually. We don’t necessarily need to know the destination to begin the journey.
Do you think there are unique benefits/synergies to individuals, each at a different point in their positive change journey, working together?
While we are presently working through details of a potential ‘combined’ program, I do believe that there are special benefits. Most people come into treatment unclear about what their ideal relationship to substances is. In the course of treatment, it’s natural to experiment with different goals, whether abstinence or moderation. People at different points of exploration and discovery can really support each other by coming from different vantage points and sharing their experiences. There is also a great benefit to retaining your support group while going through the process of discovery.
The different points and stages also represent the real world. In a combined, mixed goals approach, people get to have the experience of being with a diverse group of their peers. They have an opportunity to bring up all sorts of important and challenging issues, and the feedback and support can really help them get clear about what their ideal choices may be. When one discusses combining individuals with different goals, there tends to be a concern that interacting with others who are exploring moderation may be triggering to those choosing abstinence. The best and safest place to be triggered is within your group, where you clarify the vulnerability and have deep and unfailing support.