G. Alan Marlatt, Ph.D., is the director of the Addictive Behaviors Research Center and Professor of Psychology at the University of Washington. He has written numerous books, including Overcoming Your Alcohol or Drug Problem, and holds a Senior Research Scientist Award from the National Institute on Alcohol Abuse and Alcoholism. Below Marlatt outlines a controversy in treatment for us. Please feel free to leave your feedback in the comments section.
Controversy: Is Abstinence the Only Acceptable Goal in Addiction Treatment?
-Those who identify with a strict disease model of addiction insist that total abstinence is the only acceptable goal for participation in drug treatment or involvement in 12-Step programs such as AA and NA.
-In the disease model, there are only two possible outcomes following treatment or a commitment to total abstinence: you are either successfully in recovery (clean and sober) or you have relapsed (even if you only had one drink or a single episode of drug use).
-The alternative approach is known as harm reduction, in which the goal is to reduce the negative consequences of drug use, particularly for those who are unable or unwilling to pursue an abstinence goal (e.g., needle-exchange programs for injecting drug users, to reduce the risk of HIV transmission).
-For therapists, the best strategy is to help your clients to follow their own goals, either abstinence or harm reduction. By doing so, therapists are more likely to keep their clients involved in behavior change, instead of using a confrontational approach. Acceptance and motivational enhancement are the most effective means to get the message across.