Harm Reduction Therapy (HRT) integrates mental health and substance use treatment and offers it to people who actively use drugs and whose lives are so traumatized and chaotic that they cannot meet the conditions of most programs and clinics. Either they avoid those programs for being too demanding or they are excluded from those programs for “behaviors” that are considered disruptive. 

HRT is part of the harm reduction movement, a grassroots social justice and public health movement to end the racist War on Drugs that overwhelmingly targets black and brown people and that has contributed to the United States incarcerating more of its people than any other nation on earth.  

HRT is based on the reality that behavior change is usually slow, and a leap from active substance use to complete abstinence is almost always unrealistic and often unnecessary to reduce or eliminate harm. Coercion and punishment are not helpful and, in fact, impede the process of true change.  Harms from drinking and drug use can, and should, be reduced as quickly as possible without hanging onto the hope that a person will quit all their drugs.  Harm reduction offers many strategies to reduce harm and save lives, and harm reduction therapy helps people reflect and consider other changes to their relationship with drugs.

Introduction to Harm Reduction: This short video highlights the radical notions of harm reduction and the basic principles of harm reduction therapy.

What is unique about HRT?

Relationship with drugs

HRT is founded on well-established understandings of humans’ relationship with intoxicating drugs and on what motivates us to change. 

  • People use drugs for reasons.  There is no time in human history when we have not sought and used intoxicating substances- for pleasure, religious and cultural ritual, enlightenment, or for relief of pain and suffering.  We say that people have a “relationship with drugs” and, like all relationships, some are healthy, others unhealthy, and people experience ups and downs with their substance use throughout their  lifespans.
  • Self-determination is key to motivation.  When people are offered a relationship that respects their autonomy and acknowledges their competence, they are much more highly motivated.  Research also shows that when we are offered choices instead of mandates, we tend to make healthier ones.  Why?  Because our resistance is not aroused and we feel empowered when we have freedom of choice.  Those are the conditions for motivation!
  • Change occurs in steps, or stages – most of us are not ready for change at the moment we realize something is wrong.  We need to embrace and explore our ambivalence.  Others are ready for action and need help to plan and execute change.  At HRTC, we are adept at helping people to identify their stage of change and to successfully move from one stage to another.
  • Integrated treatment works best for people with multiple intersecting issues.  Harm reduction therapists are skilled and able to respond to mental health, substance-related, and other life issues.  What comes first is determined by the client, sometimes in consultation with the therapist, sometimes not.

What It Takes to Practice Harm Reduction Therapy: In this short video, Jeannie and Patt talk about their unique perspective on drug use, including the importance of recognizing the benefits that people get from drugs, not only the harms. They also challenge therapists to learn to be comfortable talking about drugs with their clients.

Harm Reduction Therapy works because it is:

  • Individualized: Each individual’s relationship with drugs and alcohol is different -substance misuse develops from a unique interaction of biological, psychological, and social factors.  We understand that people use drugs for a variety of reasons and we work hard to help each client understand their own motivations.
  • Client directed: We empower clients to prioritize which problems they want to address and to set goals.  We do not insist on particular outcomes.  Research tells us that when clients select their own goals, success is much more likely, and one success leads to another.
  • Respectful and compassionate: We are committed to developing a deep understanding of our clients, and helping create positive outcomes for them.
  • Non-dogmatic: We do not ask clients to adopt labels such as “alcoholic or addict”, or to believe that they have a disease, in order to change or quit substance use.

Guiding Principles of Harm Reduction Therapy

HRTC’s guiding ethos  is “Come as you are, take what you need, leave when you’re ready.”  The structure and the process of our work are organized around this principle of client-centered care.

Come As You Are 

HRTC welcomes everyone, especially the people other mental health and drug treatment agencies turn away or alienate.  There are no criteria for coming to HRTC, and we work with what people want, not what we think they need.  We work at their pace, not ours.  

We believe in hospitality first.  We treat people as we would if they came into our own home.  We want to make sure people are comfortable so that they can attend to the very hard work ahead of them should they choose to change their relationship with drugs or other aspects of their lives.  We offer cold and hot drinks, hot cooked food, and lots of great snacks so that people are nourished and cared for.

Our caring hospitality builds trust that people can rely on us.  As one participant advertised as he rode his bike down the alley waving one of our grilled cheese sandwiches, “You gotta get up here!  You can talk to these people.  THEY LOVE US!”

Take What You Need

We offer people a menu of options.  We ask them what they need and we work very hard to give them what they ask for.  We believe that whatever we have – whether information or resources – belongs to our clients.  We act as generous hosts, not as gatekeepers who determine what people get to have or not have.

Leave When You Are Ready  

We meet people “where they are at”, emotionally, motivationally, and literally.  We go where people live and hang out, and we adapt to their needs.  Clients at HRTC direct their care, identifying the areas that they need help with. This autonomy and self-determination keep them invested in their treatment.  All of our services are offered on a drop-in basis.  People come and go as they see fit.  We believe that people know when they are ready to pause or when they have arrived at a satisfaction point.  They get to take breaks, they get to leave, and they get to come back whenever they want.  We believe in people’s wisdom to know what they need and when they need it.