Harm Reduction – Why I Consider It a Viable Option by Kate Bartenhagen, MFT

Harm Reduction – Why I Consider It a Viable Option by Kate Bartenhagen, MFT

Harm reduction is often a controversial approach to treating addiction and/or minimizing the impacts of alcohol abuse or drug abuse. In her guest post, Kate Bartenhagen, MFT, shares her views on why she now considers harm reduction a viable option in her work as a family therapist to reduce suffering and improve relationships.

Kate Bartenhagen, MFT, explains why she considers harm reduction a viable option.

Kate Bartenhagen, MFT, explains why she considers harm reduction a viable option.

Kate Bartenhagen is a Licensed Marriage and Family Therapist who graduated from The Institute of Transpersonal Psychology (currently Sofia University) in Palo Alto, CA (2009). She has worked in the mental health field for 20 years. Areas of interest include mood disorders such as anxiety and depression, substance abuse/recovery issues, women’s issues, and life transitions which may include a search for meaning. She enjoys working with individuals, couples, families, adults and adolescents. Her approach to mental health is a strong belief that people strive towards wellness and have within them the capacity to grow emotionally and spiritually. Ms. Bartenhagen has a bachelor’s degree in English Education (1987) and a Master’s Degree in Counseling and Human Development/Mental Health (1990), both from the University of Iowa. She has also worked with victims and offenders of domestic violence, with families in the court system and foster care system, and in both inpatient and outpatient substance abuse clinics. She can be reached at katebartenhagen@yahoo.com.

Harm Reduction – Why I Consider it a Viable Option by Kate Bartenhagen, MFT

My beliefs about substance abuse/addiction and treatment have evolved.  Early impressions were made from observing family members, and the belief that developed was, “People who drink are more fun/funny than people who don’t.”  After testing out that theory throughout high school and college, I grew to believe  that the “disease of addiction” was a myth – anyone could control his drinking/drug use if he desired.  I have a much more complex and rich view of use, abuse, and addiction today.

I battled addiction for 25 years before realizing that I, personally, cannot drink or use drugs in moderation.  It was a painful, difficult process that has resulted in my commitment to the mental health and substance abuse fields at their intersection –  Dual Diagnosis Treatment.  So why, you might ask, would I consider harm reduction when I follow abstinence?  The short answer is that my goal as a Marriage and Family Therapist is to reduce suffering and improve relationships.  The long answer contains four assumptions.

First, I believe that human beings strive for wellness.  I use the term “wellness” to convey that which we all seek (peace, love, security, comfort, belonging, health).  Almost no one wishes to suffer and certainly no one sets out to become an alcoholic/addict.  Addiction inevitably leads to immense suffering physically, emotionally, psychologically, and spiritually. So why do people use?

This brings me to my second assumption – that people will do whatever it takes to end suffering.  Consider someone who is feeling down.  If healthy coping skills have been taught (and work) then they will likely be used again (running, dancing, reaching out for support, etc). For many people, however, either their mental health issues are severe and/or they did not learn healthy coping skills.  So what happens when a teen with chronic anxiety drinks alcohol and – for the first time in her life – feels a sense of well-being?  Calm washes over her.  Problems dissolve.  She can talk to others.  She may use alcohol again.  And again.

So my third assertion is that alcohol and other drugs alleviate suffering for some people, particularly for those with an undiagnosed/untreated mental illness.  Many drugs of abuse are associated with particular mental health issues.  People with ADHD and anxiety often use marijuana.  Alcohol is used by stressed out, anxious, or depressed individuals.  Opiates initially reduce physical and/or emotional pain and trauma.  The addiction is not immediate, but the relief is.  Therefore, the pattern of use is established long before the problems of abuse and addiction develop.

My fourth assumption is that we are each on our own individual path.  Each path is unique and each person takes his or her own unique journey.  Who am I to tell someone how to live his or her life?  The truth is, clients have always had the choice. And clients ultimately make their own decision whether we agree or not (as it should be).  MFTs are trained to collaborate to reach treatment goals with client participation.  Because addiction treatment grew out of Alcoholics Anonymous (AA) and because nothing had been found to work effectively with addicts previously, the AA model of abstinence has become the predominant model.  While I believe this approach can be highly effective for some, it misses many.  There are as many treatment options as there are individuals.  I have met many clients who still have money, jobs, family, and they are not willing to call themselves an addict (and maybe they are not).  But they are willing to acknowledge that something is wrong and may be willing to look at alcohol/drug use if abstinence is not presented as the only option.

Harm Reduction – a starting point that realistically addresses the stigma associated with abuse and addiction and the reluctance to label oneself as an “addict.”

So we need compassion for abusers and addicts (and the family members), not judgment.  People arrive at my office at all stages of use, abuse, and addiction.  I meet the client where they are and consider all possible treatment options.  The critical point is that the person is asking for assistance and therefore is appropriate for therapy.   Would I suggest an addict try harm reduction?  Well, if they do not see themselves as an addict and won’t consider abstinence, then the answer is “Yes.”  Reducing harm is preferable to creating an atmosphere in which clients leave because they don’t fit our treatment model OR worse yet, they don’t tell us about drug use and we don’t ask too many questions.  I cannot end all suffering, but I can reduce it.  That means creating a trusting, open, honest relationship with my client, helping them look honestly at their mental health issues and drug use, and taking whatever steps they are willing to take at this time to reduce their suffering and create more safety and space to continue their journey of self-discovery.  SAMHSA recently released a statement regarding Recovery-Oriented Practice:

“One principle we consider important to emphasize throughout the presentations is that the issues of choice and self-determination are central to the notion of recovery—both in terms of recovery from substance use disorders and recovery from mental illnesses. We know there are many pathways to recovery, that recovery is a unique journey for every individual and family, and that the person himself or herself must be the primary driver of this process. The days of unquestioning compliance with expert practitioners are over—if, in fact, that was ever the real situation.”

Harm reduction is a starting point that realistically addresses the stigma associated with abuse and addiction and the reluctance to label oneself as an “addict.”  It allows the client and therapist to have an honest, open discussion about the client’s use, and it serves to reduce suffering immediately while treatment progresses.



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11 Responses to Harm Reduction – Why I Consider It a Viable Option by Kate Bartenhagen, MFT

  1. Kathy Foster says:

    Nice blog, Kate! I like the elements of Dr. Mee-Lee and Buddhism blended together. The idea of taking a person where they are at and helping them look at if what they are doing is helping them get to where they want to be makes a lot of sense. I work with a variety of issues with discharging inmates, many of whom have substance abuse/dependence diagnoses and many of them have co-occurring disorders. If I just try to steer them to services that I think they need, I am wasting my time and theirs. If it is not their agenda, it will fail. That is a failure for more than just them since resources are scarce and there are others who need AND want those resources. They might fail anyway, but they learn from it more if the choices are theirs. I think it is more recognized now that relapse is a part of recovery and that we should not shame someone for set backs. Growth does not happen all at once. It is a process and we should not try to short-change that process. I look forward to more posts!

    • Kate Bartenhagen says:

      Thank you for your comment, Kathy. I appreciate hearing about your experience working with inmates. My ultimate goal is to de-stigmatize mental health and substance abuse issues, starting with my own self-disclosure. I reframe relapse to my clients as an opportunity to learn more about their addiction. If we look at each stage of recovery (from drugs and mental health issues) with curiosity rather than judgment, we can learn a lot about ourselves and our triggers. Curiosity and compassion provide the space to explore all of who we are and how we react to various triggers both internally and from our environment. It is great to hear that others are coming to similar conclusions in their work with dual diagnosis.

  2. Herby Bell says:


    With all of the confusion about addiction and its treatment, you got my attention immediately with your, “My beliefs about substance abuse/addiction and treatment have evolved.” Compassion…what a concept and model you offer for our way forward in helping more people with this pervasive challenge in our culture.

    Thank you for clearly explaining what harm reduction is and how it can be a part of this healing journey of addiction recovery. Great post.

  3. Kate Bartenhagen says:

    Thank you, Herby. I feel honored to be working with you on this personal and professional journey.

  4. Kyczy says:

    Thank you for this post – I am sharing it with others as well. You have laid the issue out so clearly and with such understanding. Be well

    • Kate Bartenhagen says:

      I appreciate your feedback. It is difficult to know if one’s thoughts will resonate with others, so I am pleased it spoke to you!

  5. Carolyn says:

    Kate, thank you for this article. I often work with former addicts (in recovery) who have been forced into rehab because of the pressures of family and society. There are MANY relapses, and relapses are now expected in the process of recovery….this may be because it wasn’t the addicts idea to go into recovery, proving your point that “choice and self-determination” is key in treatment. My question is, however, how do you determine with whom to use Harm Reduction? Addicts overdose/black out (depending on their drug of choice)because they are in an altered state and unable to logically understand when to stop. Perhaps I’m misunderstanding Harm Reduction?

    • Kate Bartenhagen says:

      Hi Carolyn,

      GREAT question. Harm reduction is not the same as “controlled use.” Harm reduction is helping the patient to make changes that reduce risk in the short term if they will not agree to abstinence. Safety is always number one, so if someone needs detox or inpatient, I will do everything in my power to get them that help. Because addiction is progressive, however, it is often NOT an immediate crisis that brings the person to an outpatient office. So I may be able to see the potential dangers (as with someone who has depression and has suicidal ideation but no plan). In these cases, we start with harm reduction – I explore what and when they are using and with whom. I ask if they have access to clean needles. I ask if they are drinking/using and driving. We start with these issues and try to make their use safer if they are not willing (or able) to get into treatment. I am speaking to them when they are NOT using (hopefully) about choices they can make IF they choose to use (and educate them that they are making decisions with an impaired brain, even when not using). All the while, we are gathering data about their use, their ability (or lack thereof) to control their use, and triggers. This can lead to immediate changes in behavior which can help them see the benefit of altering or ending their use. Hope this helps!

  6. Amal says:

    Thanks for your explanation.

    My question is that what data/information or any outcome data do we have that establishes harm reduction as a viable policy?

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