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Understanding the Harm Reduction Model (Controlled Drinking)

By Dr. Britt Gottlich, Psy.D.

According to the National Survey on Drug Use and Health performed by the NSDUH, “[A]bout 7.3 percent of adults ages 18 and older who had Alcohol Use Disorder in the past year received any treatment in the past year… People with Alcohol Use Disorder were more likely to seek care from a primary care physician for an alcohol-related medical problem, rather than specifically for drinking too much alcohol” (NIAAA). Why? Seeking help for substance abuse can be overwhelming and scary.

Often, clients report that coming in for the initial appointment is the hardest part due to the unknown of this type of treatment program. What clients often do not expect, is that substance abuse treatment can be flexible and meet them at a common ground. We like to call this approach “harm reduction.”

What is Harm Reduction?

Harm reduction is a term used to represent “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs” (National Harm Reduction Coalition).

The concept behind harm reduction is meeting the client where they are in terms of their commitment and motivation to change. Abstinence is a very overwhelming concept for individuals, which can often push them away from seeking or continuing treatment. Therefore, this approach allows the client and their treatment team to come up with a specific plan that allows them to use their substance of choice in a moderate and safe way.

Harm Reduction for Alcohol

We often find that clients seeking alcohol treatment are interested in a harm reduction model. This is likely due to alcohol being both legal as well as socially acceptable. Imagine, as a young adult, you are aware that you drink too much and want to seek help. Likely, the concept of abstinence would be overwhelming, as alcohol is a major part of our culture. We see alcohol in the media, at events/parties, and at dinners and happy hours. Expecting someone to potentially cut those events out of their lives to reduce the exposure to alcohol is not always realistic. According to research, “Many individuals experiencing problems related to their drinking (e.g., college students) are not interested in changing their drinking behavior and would most likely be characterized in the precontemplative stage of the transtheoretical model. Harm reduction provides a good method for matching these individuals at that stage and providing motivational incentives (e.g., discussing the negative consequences the person is experiencing) to motivate their desire for positive change” (Marlatt & Witkiewitz, 2002).

Therefore, for those clients who find complete abstinence to be overwhelming, we will come up with specific rules around their drinking. “It is essentially a practical approach; success is not measured by the achievement of an “ideal” drinking level or situation (i.e., abstention or low-risk levels), but by whether the introduction of the prevention measure reduces the chance that adverse consequences will occur” (NCBI).

How Does Harm Reduction Work in Therapy?

In regard to my therapeutic approach to harm reduction as a clinical psychologist, I usually start by understanding my client’s goals for drinking. We then start the process by monitoring their drinking as is, to understand the baseline they are starting at. This will include logging numerical data, but more importantly, triggers and impulses behind those drinks to better understand their motives. Together, we will come up with specific rules to help decrease their consumption. This could include the number of days they drink per week, the number of drinks they have at a time, specific types of drinks they allow themselves to drink, as well as building awareness behind the types of emotional drinking they may engage in. Most importantly, this treatment model provides accountability, where clients are working weekly and sometimes more with their providers to monitor their progress.

Harm Reduction VS Abstinence

While harm reduction can be effective and successful in helping a person be more cognizant of their drinking behaviors and therefore decreasing them, it is not for everyone. While, of course, no one is perfect, and we expect “mistakes” or “hiccups” along the way, there are some individuals who try harm reduction and are able to recognize they cannot exercise this type of self-control. In those cases, harm reduction can be a helpful tool as a last resort, to help the individual come to the conclusion themselves that abstinence is the right avenue for them, rather than having it enforced upon them at the start of treatment.

Is Harm Reduction Right for Me?

It is important to know when seeking treatment for substance use that there are options. A field that used to be very black and white in its approach has many areas of gray that may be a good fit for you. Reach out for help and engage in a conversation with your provider about all the treatment options that are available to you.

Dr. Sam Glazer, a NYU professor of Psychiatry, and his team at Fifth Avenue Psychiatry provide private alcohol addiction treatment in the Manhattan, New York City area and offer controlled drinking programs.


  • G.A. Marlatt, K. Witkiewitz / Addictive Behaviors 27 (2002) 867–886