In the world of addiction, moderation has traditionally been a dirty word. Harm reduction has started to change that. Harm reduction is a philosophy that approaches change compassionately. The aim is to reduce negative consequences associated with the behavior in question and celebrate any positive change, no matter how small. The motto “Come as you are,” captures harm reduction’s foundation in humanistic and client-centered approaches.
Moderation management for alcohol and drug abuse has gained awareness as an alternative intervention to abstinence, however clinicians who treat process addictions, such as compulsive sexual behavior and kleptomania, have been doing harm reduction by default. For example, most patients who seek sex addiction treatment aren’t looking to abstain from sexual behaviors or activity, but rather to develop healthy sexual behaviors. Likewise, patients in compulsive shoplifting treatment programs aren’t told to restrict themselves to online shopping, but instead learn why they behave impulsively and create alternative, healthy coping strategies. Furthermore, Harm Reduction Psychotherapy, which addresses both the compulsive behavior and underlying mood or personality disorders, fits process addiction treatment like a custom knit glove. So many patients with process addictions act impulsively as a means of self-medicating depression, anxiety and trauma, much like someone who misuses drugs or alcohol as a way of coping.
So what does this mean for the future of process addiction treatment? If we utilize a harm reduction approach to treatment, we can help the patient reduce negative consequences, increase their self-efficacy and motivation to change. We do this by celebrating small successes, helping them understand the meaning of their impulsive behavior with the use of integrated psychodynamic, cognitive-behavioral and attachment theories, and reduce the paralyzing shame and guilt that encumbers initiation in treatment by encouraging patients to come as they are.
Jennifer Fernandez, MA