New Website! The Abstinence Alternative Harm Reduction site from Dr. Andrew Tatatarsky

The Abstinence Alternative Process is now available for free on my new website.

It has a series of questions designed to encourage reflection on one's substance use and the process guides people through an evaluation of their substance use, the complex ambivalence to changing, positive change goal setting and making a personal plan for change.

Please visit www.andrewtatarsky.com. I welcome comments and suggestions.

Dr. Andrew Tatarsky on Change Talk Radio (July 6, 2011)

Dr. Tatarsky explores the limitations of traditional abstinence-only treatment, the elements and process of Integrative Harm Reduction Psychotherapy and the Abstinence Alternative Framework and the life-saving value and limitations of AA. He told the story of a successful harm reduction therapy participant and how the approach was necessary to facilitate his positive changes when traditional treatment had been unsuccessful.

Listen to my new episode Harm Reduction with Dr. Andrew Tatarsky at http://tobtr.com/s/1960059.

The AA Debate: Life Saving Healing Community or Dangerous Cult?

I have been in the field for over 30 years, primarily offer psychotherapy to people with drug and alcohol problems and supervise and train professionals in this area. I think we as a field need to get to the bottom of this debate about AA. We as a community, zealots and nay sayers unite!

AA has been wonderful, life saving and growth enhancing for many of my patients, colleagues and family members. AA has been irrelevant, damaging or silly to many of my patients, colleagues and family members. Both true. Lets all face these facts that we know to be true. I am anti-dogma. The problem with AA is not AA but the idea that AA is the only way. It kind of was when the founders of AA got together while they were drinking to hang out and talk. It is no longer as we all know.

As people who are all concerned about and wish to be of help/service to people who struggle with substance use, we need to consider that AA may be useful to some people and may be dangerous to others when we consider making a referral to AA.

We need to gather the research! Can we all commit to working together as a team to gather and examine the data? If not we are not really interested in truth, rather interested in promoting our dynamically driven narcissistically invested agendas.

Foisting these agendas on each other and our patients is not interesting and potentially traumatizing to patients. If the therapeutic alliance is paramount, we must put our agendas at the door when we go to work. This radical stance enables us to meet our patients open to creating a space in which they can be themselves, invite us into their experience as unique individuals and collaborate on the project of clarifying the nature of their struggles so we can decide together what goals and positive change plan is right for them.

I call this Integrative Harm Reduction Psychotherapy. and think it is essential to any effective treatment. This emphasis on a radical non-ideological therapeutic stance with the patient enables a space in which all self-help and evidence-based practices can be considered together in the search for an integrative whole person plan that is uniquely suited to each individual.

I am committed to gathering the research and will make the database available to the community. Please share your thoughts, research and citations for us to consider together.

Andrew

A Love Poem for Alan Marlatt

I read the following at the Memorial for Alan Marlatt on Sunday, May 15th in Seattle.

A Love Poem for Alan Marlatt
by Andrew Tatarsky

How do I honor and celebrate the life and work of Alan Marlatt? He was such an important person in my life personally and professionally and an icon in the world.

I have an image of Alan’s warm gentle face with his impish smile and sparkling eyes in the upper left side of my mind’s eye, floating like a smiling Buddha, filling my heart with love and bathed in my gratitude for what he gave me and brought into the world.

To me, Alan was a rock star! He used his warmth, compassion, courage, commitment, intelligence, creativity, power, relationships and professional stature and position to advance the best of causes. Like Marley he sang beautiful songs of compassion, acceptance and love. Like Dylan he sang moving, persuasive songs about social justice and progressive change.

Alan was my most important mentor, cousin by marriage and a very special friend. Living on opposite sides of the country, whenever we saw each other it was a special occasion. We always brought the best parts of ourselves to each other. He was an elder in my tribe. He was like the big brother I never had, watching my back. I can’t communicate how deeply grateful I am to Alan for who he was and for having him in my life and how sad I am at losing him.

As he did for countless others, Alan saved my life, he liberated me from the ideological delusion that dominates our cultural narrative about substance use, addictive behavior and their proper treatment. Growing up professionally in the age of anti-psychological disease-thinking and failed, abstinence-only treatment, I was caught in the gut-wrenching grip of a paradigm that was accepted as received truth yet failed to be helpful to most. In the late nineties I began experimenting with blasphemous non-abstinence oriented therapy with active drug users and to my surprise it worked with many. I called Alan to talk with him about my experience and he liberated me with the words, “You are doing harm reduction.” He introduced me to this new collaborative, empowering helping paradigm and my career path and mission revealed itself: to draw out the implications of harm reduction for psychotherapy. This deeply meaningful journey has guided my life since.

As if facilitating my liberation was not enough, Alan than helped shape the journey by offering advice, guidance, support and opportunities all along the way. His generosity was boundless. Alan chaired the first panel on harm reduction psychotherapy at the first national harm reduction conference and I gave my first significant talk on the subject on that panel. A year later Alan edited the first professional journal issue devoted to harm reduction psychotherapy and invited me to write my first significant article on harm reduction psychotherapy. A few years later Alan wrote the introduction to my book. He was a founding member of the Association for Harm Reduction Therapy along with me and several others, Patt Denning, Jeannie Little, Fred Rotgers and George Parks. Last year he invited me to have the honor of co-editing with him the second special journal issue on harm reduction psychotherapy.

Like me and you, Alan was a complicated multidimensional human, embodying contradiction, suffering and conflict but committed to growing and healing and transcending the challenges of a difficult past, all the while a giant in American psychology, a trailblazing, courageous scout leading the movement for compassionate progressive treatment in the addictive behaviors field for nearly 40 years. He was at the forefront of controversial change at every step. As he did with me, he mentored and helped establish the careers of countless colleagues who will carry on his legacy, promote his ideals and find inspiration from his life. He had more work to do, he was not done, life was so generous to bring Alan into our lives and so cruel and incomprehensible to take him as it did. His life and his work teach the challenge to compassionately accept what is and who we are while simultaneously striving to grow and evolve toward our highest ideals.

Alan, your guiding life lives as an inspiration for me and the world.

The Question of Moderation?

The fact is that each drinker has the responsibility to figure out for him or herself if moderation is a realistic option or not. How long that takes is how long it takes. Every person who came to embrace abstinence as the most self-affirming goal struggled with this question for a long time. Moderation/harm reduction therapists offer these people professional support and guidance to figure out if moderation is possible for them. Many people who attempt moderation fail because they are not equipped with the information, skills, strategies, support and a conducive attitude to be successful. It is akin to asking someone to try driving a car safely with not training, practice, support and experience learning to drive. If problem drinking is due to a mix of biological, psychological and social factors that are unique to each drinker, a serious attempt at moderation would need to assess this complex constellation of factors and offer a personalized, comprehensive, integrative treatment plan. Otherwise it is simply a set up for failure and more "evidence" for the "disease" and "powerlessness". Many people I have treated with very serious drinking problems have been very successful at achieving stable, long-term moderation. The NIAAA studies suggest this is much more common for treated and untreated "dependent" drinkers than people in this group have suggested. I have also worked with many less serious drinkers who, given the complexity of factors related to their problem drinking, chose long-term commitments to abstain because it was easier and they found that they felt better not drinking. I believe it is our job as helpers to support our clients on their paths toward healing, growth and positive change. We are to support them in discovering what is true for them not impose what we believe to be true on them. This derails true growth and empowerment if not any chance that the treatment will be helpful. It also risks re-traumatizing people as it sets up and replicates power dynamics that were traumatizing in earlier relationships. I have discussed these ideas in a book and papers you can download for free on my website, www.andrewtatarsky.com. I look forward to further exchange of ideas on this topic.

Dr. Tatarsky's Video of TalkTV Discussion about Harm Reduction Therapy

Dr. Andrew Tatarsky will Appear Live on Let Them Talk TV, Tuesday March 22nd at 8 PM

Tuesday March 22, 2011 at 8 PM

Paul DeRienzo and Joan Moossy host Harm Reduction psychotherapist Dr. Andrew Tatarsky on Let Them Talk live Tuesday March 22, 2011 at 8 PM on Manhattan Neighborhood Network on channels 56/83/34 and on the web at mnn.org.

The show will also be available at youtube.com/letemtalk.

Topics may include Charlie Sheen, the state of the art of drug treatment, A.A., stigma, drug prohibition/legalization, 50,000 marijuana arrests last year in NYC, choice, re-defining recovery, Tatarsky's book, Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems, pleasure, self-care, human rights of drug users, self-cure, Alan Marlatt, personal plans for positive change, awareness, curiosity and much more.

Andrew Tatarsky is a clinical psychologist, Author of Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems; Founding Board Member and Past President, Division on Addiction, New York State Psychological Association; Chair of the Board, Moderation Management Network, Inc.

Center for Integrative Psychotherapy of Substance Misuse

303 Fifth Avenue, Suite 1403

New York, NY 10016

212-633-8157

www.andrewtatarsky.com

Appreciation: G. Alan Marlatt Brought Compassion to Addiction Treatment

By MAIA SZALAVITZ
Tuesday, March 15, 2011
TIME

Many people claim to be pioneers in addiction treatment, but few have left a more important legacy than G. Alan Marlatt, professor of psychology at University of Washington, who died of melanoma on March 14, at age 69.

Marlatt, who was also the director of the university's Addictive Behaviors Research Center, was one of the first researchers to understand the importance of relapse in addiction treatment — and, more importantly, to develop and systematically test ways to help prevent an addict's momentary slip from becoming a full-blown relapse. Marlatt recognized that enforcing immediate abstinence often deters substance users from getting or adhering to treatment, and he advanced therapeutic approaches that focus on reducing alcohol- or other drug-related harm, without demanding strict abstinence.

Throughout his life, Marlatt labored to bring empathy and compassion into a field that had historically advocated harsh and coercive techniques that were not effective.

"Alan had an enormous influence on the addictions field that continues beyond his passing," says Reid Hester, director of the research division of Behavior Therapy Associates, a clinical and research psychology program in Albuquerque, and himself a long time leader in addiction research. "His focus on harm reduction lowered the barriers for many to engage in treatment and self-change of their addictive behaviors. He was also warm, empathic and a dear friend to many. For those of us who knew him, he will be sorely missed."

Marlatt also developed techniques to reduce harm associated with college binge-drinking, and his most recent studies had explored the use of mindfulness meditation in recovery from addictions and depression.

His friends, family and colleagues remembered him with great admiration:

"He showed that people with substance abuse problems need to be met 'where they're at, without prescriptions for what recovery 'should' be," says author Anne Fletcher, who worked with Marlatt on her book Sober For Good.

"It is impossible to recount briefly how much Alan has meant to the field of addiction psychology, to addictions treatment and research, and to substance users not in treatment through his advocacy of harm reduction," wrote Fred Rotgers, president of the American Psychological Association's (APA) Division on Addictions, in an email posted to the APA's listserv.

"Alan was a trail-blazing, game-changing researcher, clinician and academic. He was always out on the edge, challenging conventional wisdom in search of what is true about substance misuse and what is most helpful to people struggling with these issues. He was an early researcher examining controlled drinking. He was the person who invented relapse prevention," says Andrew Tatarsky, a New York City psychologist specializing in addictions and a cousin by marriage to Marlatt.

I knew Marlatt through my work writing about and trying to understand my own addiction. When I look back through the stories in which I've quoted him, his kindness and sympathetic nature come through in every sentence. For example, in an article about New Year's resolutions and staying on the wagon, this is what Marlatt said about dealing with relapses:

For starters, don't berate yourself for being weak. Instead, tell yourself, "I made a mistake. What can I do differently next time? How can I learn from this?" says Marlatt. "This happens to almost everybody. It's not just you."

One of the most common mistakes addicts make is focusing on whether they are strong enough to change rather than on specific methods of coping. "It's like trying to ride a bike," says Marlatt. "You make mistakes and learn, and you don't give up if you don't immediately find your balance." If the bicycle is missing a wheel or is otherwise broken, then it requires fixing — simply willing it to work is not going to help you ride.

Also, says Marlatt, "most people think that if they have urges or cravings, there's something wrong, that you're not supposed to have them." In fact, they are a normal part of habitual behavior. "Notice and accept them."

In a world so often focused on "treating" addiction with tough love, Marlatt showed through his work and his life that kindness simply works better. R.I.P., Alan: you are already missed.

Read more: http://healthland.time.com/2011/03/15/appreciation-g-alan-marlatt-brought-compassion-to-addiction-treatment/

In Defense of Charlie Sheen

By Andrew Tatarsky, PhD

Charlie Sheen has been making outrageous-sounding claims about his treatment for substance

abuse that fly in the face of conventional wisdom. But is he wrong?

On NBC’s Today Show, Mr. Sheen declared that he has cured himself of his addiction. On CNN’s Piers Morgan Tonight, Mr. Sheen went further saying, "I don't believe myself to be an addict. I think that I just ignore or smash or finally dismiss a model that I think is rooted in vintage balderdash.”

He has also rejected Alcoholics Anonymous, the icon whose principles dominate addiction treatment in this country, calling AA’s approach “fiction” and pointing to its "5% success rate." After 22 years of addiction treatment, Sheen turned to self-help at what he called the”Sober Lodge”-- his own home.

"I close my eyes and make it so with the power of my mind,,’ he told a reporter. Is he delusional, setting himself up for a big relapse?

Mr. Sheen has had a long history of problematic substance use and related difficulties. Many of his public statements seem deliberately in-your-face. I have never met and evaluated Mr. Sheen and it would be irresponsible to comment on how true his statements about addiction and change are for him. But regardless of what you think about Mr. Sheen's provocative and sometimes destructive words, behavior and lifestyle choices, he is correct in challenging the prevailing wisdom about drug and alcohol addiction and its treatment.

A growing number of addiction treatment specialists and researchers agree with Mr. Sheen on two points: the traditional disease concept of addiction and the related "abstinence-only" ideology are not in line with contemporary thinking about addictive behavior and its treatment.

Many practitioners no longer believe that total abstinence is the only way to deal with drug and alcohol problems. Yet this extreme position has been the prevailing view since Emil Jellinek postulated a disease model for addiction treatment in 1946, basing his findings on a survey taken by Alcoholics Anonymous of its members. At the time, the disease model was a significant improvement from the previous prevailing view—that people with drug and alcohol problems were moral degenerates. For a great many people, the disease approach has been very helpful in countering the shame that can accompany serious substance use problems.

But this one size-fits-all treatment ignores the personal and social complexity related to problem drug and alcohol use and can actually set people up for failure. In fact, people can emerge from severe substance use problems with a variety of outcomes. They may drink or use drugs in moderation or not at all. They might abstain from drug use but drink occasionally. They may reach this new way of being without any treatment at all.

Charlie Sheen is correct about this: AA fails far more often than it helps, and may actually subvert other treatments that would be more effective. In a 2009 survey, The National Institute on Drug Abuse estimated 22.5 million persons (8.9 percent of the population aged 12 or older) were classified with substance dependence or abuse in the past year. Of these only 2.6 million (1.0 percent of persons or 11.2 percent of those who needed treatment) received treatment at a specialty facility. Typically, only 15-35 % of patients complete treatment and even smaller numbers actually maintain abstinence when they do complete. A major study in 1996 by the National Institute on Alcoholism and Alcohol Abuse (NIAAA) found that 70 percent of people who received treatment for alcohol dependence returned to drinking “alcoholically,” and the remaining 30%--the success stories—were split equally between abstainers and people who had “cured themselves”and drank in moderation

Despite their limitations, A.A.type programs clearly do work-- and have been lifesaving-- for many people. But the data suggests they don’t work for everyone, not even for most people. There is strong evidence that suggests that the best predictor of success is a good fit between the patient’s goals, needs and strengths and the treatment approach and provider. Many people with severe substance use problems benefit from non-abstinence, non-12-step approaches such as Motivational Interviewing, Cognitive-Behavioral Therapy, Harm Reduction Psychotherapy with the emphasis on therapeutic alliance and Psychodynamic Therapy. There are also many self-empowering groups with abstinence and moderation goals in addition to AA that have been around for a long time and have many dedicated, successful members. Listed in order of longevity they include Women for Sobriety (founded 1976), Secular Organizations for Sobriety, Moderation Management (founded 1994), SMART Recovery and LifeRing Secular Recovery (founded 1999).

Mr. Sheen may or may not be one of those that can sustain his positive change without treatment. But he like millions of others with mild to very severe substance use problems should never be told that there is only one path to healing, growth and positive change.

Mr. Sheen’s substance use problems may reflect difficulties with anger, defiance of other’s attempts to control him, grandiosity and omnipotence, attempts to manage the stresses and strains of celebrity and many other possible meanings that only he and a good therapist can ever really know.

Andrew Tatarsky is a clinical psychologist, Author of Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems; Founding Board Member and Past President, Division on Addiction, New York State Psychological Association; Chair of the Board, Moderation Management Network, Inc.

Training: Treating Substance Abuse and Other Risky and Addictive Behaviors An Integrative Harm Reduction Approach

The addictive behavior field is in the midst of a scientific revolution regarding the understanding and treatment of these issues. Evidence supports the complex psycho-bio-social view that these behaviors reflect an interplay of biology, personal and interpersonal dynamics within social contexts that is unique to each individual.

This workshop will introduce Dr. Andrew Tatarsky’s Integrative Harm Reduction Psychotherapy (IHRP) as described in his book, Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems, and will demonstrate how this treatment for substance abuse can be expanded to effectively treat other risky and addictive behaviors.

MARCH 19 2010

10 A.M. to 4 P.M. (Includes 1 hour break
Breakfast and Registration: 9:30 A.M
Fee: $75.00 per participant
Fee for TIMH Students: $25.00

Training Institute for Mental Health
Chartered by the Board of Regents of the University of the State of New York
115 West 27th Street
New York, NY 10001-6217
212-627-8181
www.timh.org

CLICK FOR MORE INFO & TO REGISTER

Integrative Harm Reduction Psychotherapy (IHRP) Webinar

Dr. Andrew Tatarsky will offer a three-hour webinar. The webinar will provide an introduction to his Integrative Harm Reduction Psychotherapy. He will define harm reduction, give history, rationale and theory. He will discuss the psychobiosocial process model of substance misuse and addiction, multiple meanings model and stages of change model. He will describe the Seven Therapeutic Tasks in IHRP: Therapeutic Alliance, Relationship as Healing Agent, Teaching Self-management Skills, Assessment and Treatment, Embracing Ambivalence to Motivate Change, Harm Reduction Goal Setting and Strategizing for Positive Change.

CLICK HERE TO REGISTER FOR WEBINAR (PDF)