Harm reduction approaches are effective, patient-driven alternatives to abstinence-based treatment for people who are not ready, willing, or able to stop using substances. This volume outlines the scientific basis and historical development of these approaches, and reviews why abstinence-based approaches often do not work. The authors then share their expertise about harm reduction treatment (HaRT), an empirically based approach co-developed with community members impacted by substance-related harm – a first of its kind. The reader learns in detail about the pragmatic mindset and compassionate heartset of HaRT and the three treatment components: measurement and tracking of patient-preferred substance-related metrics, harm-reduction goal setting and achievement, and discussion of safer-use strategies. This volume walks practitioners through all components, provides example scripts for use in daily practice, and illustrates the work through case studies and input from community members. Handouts are available for use in daily practice. This is essential reading for clinical psychologists, psychotherapists, and researchers who encounter people who have substance-use problems.

About the Authors

Susan E. Collins, PhD, is a licensed clinical psychologist, faculty at the University of Washington School of Medicine and Washington State University, and co-director of the Harm Reduction Research and Treatment (HaRRT) Center. Dr. Collins has been involved in substance use research, assessment, and treatment for over 25 years and has disseminated this work in more than 80 book chapters, abstracts, and peer-reviewed articles. Dr. Collins also brings her own lived experience as a person in recovery from addictive behaviors and as a woman embedded in families with the intergenerational experience of substance use disorder and harm.

Seema L. Clifasefi, PhD, MSW, is an associate professor and co-director of the Harm Reduction Research and Treatment (HaRRT) Center at the University of Washington-Harborview Medical Center. Her research lies at the intersection of substance use, mental health, criminal justice, and housing policy. For the past nearly two decades she has been part of several collaborative academic/community-based research partnerships focused on the development and evaluation of individual and community-level harm reduction programs and interventions designed for and with people who have lived experience of homelessness and substance use problems.

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