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Summary: Move over AA, there's a new kid on the block
Review: Andrew Tatarsky and his contributors have brought the honesty, the sympathy, and the efficacy of harm reduction into the treatment of substance users, and it's about time!"Just Say No" has failed 95% of drug users who seek treatment to have better control over their life and their substance use. It has failed them because drug use is not a disease, and abstinence is not a cure. Men and women (and young men and young women) use drugs for their benefits, although drugs, of all kinds --licit and illicit-- are not without their risks. However the risk of developing a drug (and/or alcohol) problem does not derive solely from the drug. Tens of millions of people have had positive experiences with alcohol, marijuana, opiates, and psychydelic substances. Doesn't it make sense to identify what internal and what external factors cause a particular individual to suffer from a drug problem, rather than proclaiming drug use itself as a sickness. Standard abstinence therapies and their institutions function by glorifying guilt, helplessness, and continuous self degradation. Standard abstinence therapy fails the overwhelming majority of people. Tatarsky's book demonstrates, through well written and sympathetic case studies, another way to help people who have problems with their drug use, and it seems to be a better way. This book can make a huge difference in the lives of millions of people.
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Summary: A More Humane Approach
Review: Those of us who struggle to control our own alcohol or drug use, or who live with someone who is trying to cut down or quit, may greet the harm reduction approach, persuasively presented by Dr. Andrew Tatarsky, as good news indeed. A practicing psychotherapist, Tatarsky is concerned with meeting clients "where they live": In the context of drug and alcohol abuse, this entails exploring the meanings these substances hold for the individual user and grounding the therapy in the process of self-discovery---rather than requiring abstinence from the outset, which is the traditional "one-size-fits-all" approach to counseling. The book describes ten cases, each from a different therapist who practiced "harm reduction" in treating his or her client. Many readers will be both riveted and moved by the experience of peering into these intimate sessions. The stories are well told (if somewhat unevenly written), and their subjects come across as real people. Even more compelling is Tatarsky's framing commentary, which draws out the significance of each case: the complex interaction of personal and social factors that led this particular individual to seek meaning (liberation, escape, validation) in drug use. As to alcohol abuse, which is a component in most of these case studies, the harm reduction approach is controversial in not prescribing an outcome from the start. It flies in the face of conventional wisdom, which holds that "problem drinkers" (read, alcoholics-in-the-making) lose control after just one or two drinks. The individuals portrayed so appealingly in this book are empowered by their therapists to explore the space between quitting altogether and drinking to excess. About half of them achieve stable moderation; the others discover for themselves that abstinence is the more comfortable and successful route to reducing the harm in their lives. Readers who are not clinicians but worry about these matters will find fresh insights in this accessible introduction to harm reduction. Personal change is an intensely emotional journey best undertaken in the company of a wise therapist or caring support group. The book should be read by every psychotherapist, social worker, and counselor who deals with problems of substance abuse, directly or indirectly---that would be just about all of them. Then, they might wish to recommend the book to those of their clients who are ready for it. This layperson was able to identify with both clients and clinicians, engaged together in life-changing work.
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