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Wise Counsel Interview Transcript: An Interview with Patt Denning, Ph.D. on Harm Reduction Psychotherapy for Substance Abuse and Addiction

David Van Nuys, Ph.D.

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Dr. David Van Nuys: Welcome to "Wise Counsel," a podcast interview series sponsored by MentalHelp.net, covering topics in mental health, wellness, and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host. On today's show, we'll be talking with Dr. Patt Denning about an approach to addiction known as Harm Reduction. Patt Denning, Ph.D., is Clinical and Training Director of the Harm Reduction Therapy Center. Dr. Denning worked in San Francisco Community Mental Health as a clinician and Program Director from 1978 to 1993. She developed specialties in differential diagnosis, psychopharmacology, psychotherapy with seriously disturbed patients, HIV, and substance use disorders.

In 1993, she founded Addiction Treatment Alternatives, a comprehensive assessment treatment and training program based on Harm Reduction. She has a book on the subject, "Practicing Harm Reduction Psychotherapy," and is the author of several articles. Another book, this one for the general public, was released in the fall of 2003, "Over The Influence: The Harm Reduction Guide for Managing Drugs and Alcohol." You can find out more about Dr. Denning in our show notes.

Now, let's go to the interview. Dr. Patt Denning, welcome to the "Wise Counsel" podcast.

Dr. Patt Denning: Thank you very much. I'm very excited to be able to talk with you.

Dr. Van Nuys: Me, too. Let's start out with your background, you know, where you grew up, how you got into the field of psychotherapy, where you went to school, and all of that good stuff.

Dr. Denning: Sure, sure. I, actually, grew up in a small town in eastern Ohio - Steubenville, Ohio - which is famous for coal mines, steel mills, and football players.

Dr. Van Nuys: I've heard of Steubenfield.

Dr. Denning: Yes.

Dr. Van Nuys: Was it the title of a novel or a play or something? It's ringing a bell.

Dr. Denning: There is Steuben Glass, which is a big factory and everybody thinks that it's in Ohio, but, I think, it's still, actually, in Germany.

Dr. Van Nuys: Maybe that's the association I'm having.

Dr. Denning: Yes.

Dr. Van Nuys: Yes. So, excuse the interruption. You can go back to your story.

Dr. Denning: That's OK. After high school, I went to St. Louis University and was unclear about whether I was in pre-med or psychology or music. It became pretty clear that I kept breaking laboratory equipments and so I was not going to end up in medical school. It also became clear that while I could perform singing in public, I couldn't play the piano in public. So, there went my music career. So, by default, I ended up in Psychology.

Dr. Van Nuys: OK. Now, somehow, you become highly identified with an approach to addiction known as Harm Reduction. So, how did that come about?

Dr. Denning: After getting my master's degree, also in St. Louis, I moved to California because I wanted to be part of the Community Mental Health Movement. I really wanted to be able to provide a public health, mental health perspective on broad issues that people were facing. One of the things that struck me, it's the first time I ever noticed this, is that there was a clear divide between mental health and substance abuse. It had never made much sense to me. I think, partly, that's because as a child of the '60s, I had some of my best and some of my worst growing up experiences using drugs. It just didn't make sense to me that we would separate those two, and yet, that was the way it was.

Dr. Van Nuys: You say separate those two. I lost track of what those two.

Dr. Denning: Separate mental health from substance use.

Dr. Van Nuys: OK.

Dr. Denning: We were getting more and more into this dichotomous way of thinking that using drugs is bad and being absent from drugs is good. Again, I think, partly, because of my own personal experiences and partly because of the politics of the '60s, that that approach didn't make sense to me. I was aware that drug use is much more complicated and that people use drugs for reasons, and that those reasons were often very compelling. Now, the way I think about it is that there's really only two reasons people use drugs. That's either to increase pleasure or to decrease pain. Over time, I've also come to realize that the more a person uses drugs to medicate as opposed to recreate, the more likely they are to get into trouble. That's where the emotions come in. That's where feeling bad and wanting to feel better comes into play. The more you try to medicate away difficult situations or difficult feelings, the more likely that you're going to rely on that method over and over again. That's where drug use becomes a problem for people.

I was thinking about all these things, but not really doing much about it professionally until the HIV epidemic hit. I was the Director of a large psychiatric out patient clinic that was located in a public health center in The Castro, which is San Francisco's gay male neighborhood. We started seeing a lot - our patients were dying all over the place, so were our staff - but we also started seeing this horrible increase in alcohol abuse and the abuse of other drugs as well. It was very clear that the trauma of massive losses and fear and grief were driving people to be using more drugs and alcohol.

Dr. Van Nuys: Sure.

Dr. Denning: I started referring some of our mental health patients to substance abuse treatment, which is what we were supposed to do rather than try and treat them ourselves. But, most of the men would either not go or they would get kicked out or they wouldn't like it, and I'm like, "I don't understand this." So, I did a journey through a number of different substance abuse treatment programs and attended probably 50 or 60 Twelve Step meetings to see if I could figure out what was going on with these guys and how I could make referrals better. I was both personally and professionally appalled at what I saw.

Dr. Van Nuys: How so?

Dr. Denning: The treatment programs used an enormous amount of confrontation. They would yell at people and belittle them and tell them they were in denial and force them to sort of get in line.

Dr. Van Nuys: I had an experience with Synanon when I was in graduate school and kind of checked out Synanon, which was what they call a square - not that I was an addict - but the idea was to bring squares in to interact with the addicts. Boy, you talk about attack therapy, that was something else.

Dr. Denning: Yes, and it's really built on this idea, first of all, philosophically, that there's an [inaudible 180] of them. Those addicts, those people, as opposed to us, that we're a society that uses drugs, whether that be legal or illegal, and we all do it for the same reasons. So, to separate people who have drug problems out from the rest of us didn't make any sense to me. Again, partly, that was my own personal experience, but partly was also just realizing that when we start talking about us and them, we started making decisions that, historically, result in things like racism and sexism. I was seeing that same kind of a division between addicts, and I just hate calling people "Addicts." The language of it is really appalling to me, but it's those people rather than us, and then we can do anything we want to those people.

Dr. Van Nuys: Is there some other way that you prefer speaking, if not using the word "Addict?"

Dr. Denning: I talk about even though it's a little bit more cumbersome, I talk about people who have problems with 'substance use.'

Dr. Van Nuys: OK.

Dr. Denning: Sometimes for shortcut, I will use the word "Substance abuse," sometimes I'll even use the word "Addiction," as long as I sort of clarify that what I mean by 'addiction,' is sort of a generic term for somebody's who's got a out of control problem with the way they're using drugs.

Dr. Van Nuys: OK.

Dr. Denning: That they're suffering harm in their lives, they're causing harm to other people, that's what addiction is about. It's a complex process, it's not a disease. Calling addiction a "Brain Disease," is overly simplistic.

Dr. Van Nuys: Isn't that the dominant model today, or not?

Dr. Denning: Yeah, that's the only model in the United States. I mean, it's called the "American Disease Model," around the rest of the world.

Dr. Van Nuys: [laughs]

Dr. Denning: I think that there is a recognition that while absolutely their brain chemistry changes, and neurological changes that happen with the constant use of psychoactive drugs, that saying that it is merely a "Brain Disease," makes no sense given the social and the psychological aspects to it that begin the persons use to begin with. I mean, people didn't necessarily have a brain dysfunction, and they went looking for drugs to solve it. Although maybe we could come back to that, because as a psycho pharmacologist, I do have a lot of belief in the changes that happen to the brain, but let me go back more to the development of some of these ideas.

So, I got to the point where I just felt like I could not professionally refer to these drug treatment programs, nor could I really recommend that people go to Twelve-Step meetings, because what I saw there was a kindler, gentler version of what was happening in formal drug treatment.

It was still this sort of requirement that one tell one's story in the same way, which is, "I got involved in drugs and alcohol. My life fell apart. I got into AA. I became abstinent, and now my life is better." It was like hearing a religious mantra, over and over and over again.

Dr. Van Nuys: They have to confess essentially to being a sinner at some level.

Dr. Denning: Yes, and it is confessional. I mean, the origins of Alcoholics Anonymous lie in predominantly the Oxford Group, which was an evangelical Christian group that was formed by businessmen for the most part, who were really striving to combine Christian development and moral development with capitalism. They believed that a good Christian made a better businessman. So, the Oxford Group, it was partly about this moral development. They had a series of steps that included admitting that you were powerless over urges to sin, taking a moral inventory, telling people of the wrongs that you committed.

Then, when Bill Wilson and Dr. Bob became alcoholics themselves, they used some of the Oxford Group as a way of helping themselves, and as a result wrote "The Twelve-Steps of Alcoholics Anonymous," which are based almost completely on the Oxford Group. So, there is a religious, it was meant to be a religious and spiritual fellowship. It was meant to be a suggested path of development for people.

It became... And I don't want to get in too much into the history, this wonderful, wonderful history written by Charles Bufe called "Alcoholics Cult or Cure?" and it talks about the history of the development, and how AA changed over the years from being a spiritual fellowship that had some suggestions for how people could overcome an alcohol problem, to this modelific business in the United States. It's a very, very fascinating and eye-opening read.

So, I just started basically not referring people out to drug treatment and saying to my staff, "We're going to work with these people now, right here in our clinic. We're going to use the same psychotherapy techniques that we use with everybody else, and we're going to see what happens."

Dr. Van Nuys: The word on the street at that time... I use the "On the street," mostly, actually the word in academia was "Nothing else work, only Twelve-Step Programs work."

Dr. Denning: That is still sort of the battle cry of both professionals and non-professionals right now, despite all of the research that indicates that Twelve-Step is not particularly successful, that formal drug treatment, which in this country is now called the "Minnesota Model," and it came out of Hazelton. The Minnesota Model is a combination of a Medical Model and the Disease Model, and it uses predominately Alcoholics Anonymous as its basis for treatment. As years have gone by, they've added other things, Family Treatment and Trauma, and this and that, but it's all based on the Disease Model.

And that's still 95% of the treatment in this country is based on the Minnesota Model, despite the research that shows really appalling outcomes, a maximum success rate of 35%. The range in outcome studies is usually between 18% and 35% success for these treatments. The other interesting thing about the statistics is that most people who are doing the research don't count people who drop out of treatment.

So, of the people who stay in treatment, and that is often fewer than half that actually entered, so of those people who complete treatment, only 18% to 35% of them are successful if you call abstinence the success. Now, they're drinking a lot less, they're using fewer drugs, they're holding onto their jobs and their families, they're contributing to society, but they're counted as a failure, because they're not completely abstinent.

I started reading these things. I started reading research that showed, "Oh, we actually do know what doesn't work, which is confrontation. We're getting an idea of what does work, which is empathy, and cognitive behavioral interventions."

I met then Edith Springer, who I consider to be the 'grand diva' of harm reduction. She and Allen Marlap, who is my other mentor, he's up at the University of Washington in Seattle as an internationally known researcher on drug and alcohol. They both separately went to Amsterdam to see their Needle Exchange Programs, to see what this word "Harm reduction" meant, because it had been adopted as the public health philosophy in the Netherlands. And they came away from that realizing that there are fundamental values that the Dutch government had put into place, that they were calling harm reduction.

And one of the values was everybody is worth saving. Everybody has something to contribute. And, it's our job to protect people and help them deal with the harms that they may be causing, as well as to help society and help families deal with this. And they setup needle exchange programs. They setup medical vans to take care of drug using people who had medical problems who were being discriminated against. And they were having huge successes.

Dr. Van Nuys: Boy, that's a very different attitude, isn't it, then we have over here.

Dr. Denning: Absolutely, absolutely. And I think the politics of it at this point are really scary. But, when you think that harm reduction is based on the idea that everybody is worth saving, and in our country, we seemed to have made some decisions about who is not worth saving.

Dr. Van Nuys: -huh.

Dr. Denning: And if you look at our prisons, those are the throw away people. And the vast majority of people are in prisons because of non violent drug offences.

Dr. Van Nuys: Yes.

Dr. Denning: So, it's really frightening - and people often say to me "You know, Patt, you are a psychologist. You are a therapist. Why are you talking about all this politics?" And I am talking about politics because you can't separate our drug policy from our criminal justice system and from our treatment.

Dr. Van Nuys: Right.

Dr. Denning: Because it's all woven together.

Dr. Van Nuys: Yes. I can really see that.

Dr. Denning: Yeah, yeah. It's quite frightening. But so, with the encouragement of Alan Marlatt and the inspiration of Edith Springer, I decided to become more academic in my approach. And Alan opened up his extensive library to me up in Seattle. And I began researching: What is it that has worked in drug treatment? What are people talking about? And I was both excited and enraged at what I saw because - I had a lot of schooling. I like school. I loved to read. And I had never come across any of the literature that I was reading now. It was all about things called motivational interviewing and cognitive behavioral approaches to behavior change - the whole stages of change model of Prochaska and DiClemente. All of this stuff out there that these people were doing that we knew worked. And none of it was taking place in our treatment programs.

So, I just started combining - you know, I was trained as a psychodynamic therapist.

Dr. Van Nuys: OK.

Dr. Denning: I was also trained earlier on as a rogerian. And I had a lot of interest and had a post-doc in psychopharmacology. So, I was really ready willing and able to put together a multilevel and multidisciplinary theory as well as practice. And I did that over a number of years and finally Alan Marlatt said "You know, there's nobody writing about harm reduction treatment. We are all writing about research. We are writing about needle exchange. We are writing about public health. Nobody is writing about treatment. And so that's your job, Patt."

Dr. Van Nuys: [laughs]

Dr. Denning: And I am like "You got to be kidding. I have been setup"

Dr. Van Nuys: Yeah.

Dr. Denning: I swore after I finished my dissertation that I would never write another thing.

Dr. Van Nuys: I hear you.

Dr. Denning: Oh... bored. But, I was convinced that it seemed to be true that there wasn't anybody else developing a theory of psychotherapy or a model of psychotherapy for drug problems. And so, I wrote "Practicing Harm Reduction Psychotherapy," which is my first book. And it outlines - it starts out with a critique of traditional treatment. And then outlines a multidisciplinary assessment and treatment approach that I just sort of... I think it was Andrew Tatarsky actually who is in New York who first coined the phrase harm reduction psychotherapy. I don't think that's mine.

Dr. Van Nuys: OK.

Dr. Denning: Pretty sure that he used that phrase. And then we've all kind of taken it up.

Dr. Van Nuys: So, that wasn't the phrase that wasn't being used in The Netherlands then or by Alan Marlatt?

Dr. Denning: No, no. They didn't have treatment. They didn't have formal treatment that was using harm reduction.

Dr. Van Nuys: OK. And when we say harm reduction, lets spell out what sorts of harm are we talking about and for whom is the harm being reduced?

Dr. Denning: Right. The global definition of harm reduction is any attempt to reduce drug and alcohol related harm to the individual, to their families or to society at large.

Dr. Van Nuys: OK.

Dr. Denning: And as psychotherapists we tend to focus on the individual - but not always. You know, when we are mandated to report suspected child abuse that's harm reduction for the child.

Dr. Van Nuys: Yes.

Dr. Denning: It may not be harm reduction for the parents or the adult. But it's certainly harm reduction for that member of the family, the child. When we legislate seat belt laws, that's partly harm reduction for the individual, but it's also partly harm reduction for others, for the community at large so that if somebody runs into you, you don't get killed because you don't have a seat belt on. So, that's a broad idea of harm reduction in our public health interventions. And in terms of most of the public health interventions Well Baby Clinics, vaccinations things like that - meal programs in schools. All of those are harm reduction strategies and are mostly not controversial. It's only when we start talking about drugs and alcohol and harm reduction do people get a little nuts. And we tend to lose some emotional balance when we think about reducing harm that's related to drugs and alcohol. Because we have this just say no and zero tolerance policy in this country.

It's either all or nothing. You either don't use drugs. You quit. You never start. Or, you are a horrible nasty addict and you are a criminal.

Dr. Van Nuys: Yes. In your book on harm reduction you have a chapter proactively titled, "Is it OK to get high" Is it? [laughs]

Dr Denning: Right, exactly. Well, that's a moral decision. It's a moral decision that society makes as well as individuals make. I think, getting high really means altering ones consciousness. I don't know if you remember, but I did this as a kid - spin around in big circles and get really dizzy and fall down.

Dr. Van Nuys: Oh yes. And also learn to knock ourselves out to go unconscious.

Dr. Denning: Yes [laughs] That's right, that's right. Exactly. And so, that's getting high. That's altering ones conscious.

Dr. Van Nuys: Yes.

Dr. Denning: And it seems to be a basic human drive.

Dr. Van Nuys: It's pretty universal across cultures and time.

Dr. Denning: Yes, it really is. And I think the whole idea of pleasure also comes into it. That being high or intoxicated is often seen in our culture about pleasure. Certainly, there is a lot of religious intoxication that goes on in different cultures. But, in terms of social intoxication, it's associated with pleasure. And what you think about the pursuit of pleasure is going to influence what you think about getting high. Is pleasure something that we are supposed to actively pursue as part of life, as part of celebrating life as a way to counter balance all of the problems in life? Or is pleasure something - "Well, it's OK to take part in if it happens to come along, but you shouldn't pursue it." Or is pleasure the work of the devil, and should we avoid it?

Those kinds of values, some of which are based on moral values, some are based on religious, but those values help us define what we think about getting high. In our society in the last 30 years, we've decided that getting high is wrong. I'm not exactly sure historically how we decided that, but we certainly decided that getting high is wrong.

So, when you start trying to think of a treatment for people who have developed problems with drugs or alcohol, you can't lose sight of that sort of natural desire to get high. It's certainly gone array, it's gotten all messed up with people.

Dr. Van Nuys: Yeah, but in some earlier societies it was channeled more in terms of religious traditions and rituals, and so on.

Dr. Denning: Yeah, there were boundaries around the use. You drank a lot of wine at certain occasions, or you took psychedelic drugs at certain occasions, and it was standardized into the cultures. Prohibition did a lot to cause us alcohol problems, because with Prohibition and the banning of alcohol, for the first time people started drinking alcohol without any other social context to it. Ordinarily it was with dinner, or it was out in public with friends, and now all of a sudden you had to do it very secretly.

Dr. Van Nuys: Yes. Well, it's a right of passage for younger and younger children.

Dr. Denning: Right, absolutely, absolutely, yeah, yeah. So, I think that our demonizing of alcohol and drugs continues to make them very alluring for young people.

Dr. Van Nuys: Yes.

Dr. Denning: It is clear that the younger the person starts using drugs or alcohol, the more likely it is they're going to run into trouble, because their judgment isn't fully developed, their impulse control is not fully developed, and so a 13-year-old starting to smoke pot is going to have a very different experience than a 19-year-old smoking pot.

Dr. Van Nuys: Yes, and probably there are issues relating to brain development, and so on.

Dr. Denning: Oh, absolutely! I don't think we know what they are, because nobody is studying that, I'm not sure. I mean you'd have to do prospective studies, which nobody is really doing prospective studies in terms of drug use, at least as far as I know, but I would imagine, sure. That you're developing all sorts of connections into your frontal lobe during adolescence that help improve judgments, and impulse control, and abstract thinking, and who knows how some of these drugs may interfere or may enhance - who knows? Our fear of course, is that it's going to interfere.

Dr. Van Nuys: Yes. I want to make sure that you have a chance to talk about the Harm Reduction Centers that you run in San Francisco and Oakland. So, maybe you could tell us a little bit about that.

Dr. Denning: Sure. I decided to quit working for Katy Mental Health in 1993, because I could see sort of the managed care and restriction of services starting to happen, and that just really bothered me. So, I quit and went into private practice, where I was much more able also to more fully develop this treatment model called, "Harm Reduction Psychotherapy." I met a colleague, Jeannie Little, who's a social worker, who was a group specialist, and had started a Harm Reduction Group at the VA Homeless Vet Center in San Francisco. She was wanting to get into private practice and do groups, and I'm like, "Oh, great, because I don't do groups. We need groups."

She and I started talking more and more, and realized that we both missed community based work. We missed being able to work with a full range of people. In private practice, you've got to charge a fair amount of money in order to pay your bills.

Dr. Van Nuys: Right.

Dr. Denning: So, we really wanted to have something in addition to a private practice, and so we started the Harm Reduction Therapy Center in the year 2000. Now, unfortunately, that was not a good year to start getting private donations, since everything, we were in quite a financial crisis in 2000 as well.

Dr. Van Nuys: I was going to say, it's probably better than this year.

Dr. Denning: Yes, absolutely better! [laughs] It took us a couple of years to develop it and get started, but we officially started seeing clients in 2002. We have our main office in San Francisco, and we also have offices in Oakland. What then happened over time is that we started-we do a lot of professional training, and a lot of consulting in organizations, because the Public Health Department of San Francisco declared Harm Reduction to be the policy for all city programs.

Dr. Van Nuys: Yeah!

Dr. Denning: Yeah, and this happened, I can't remember exactly when, but probably in the year 2000, maybe in the year 2002. So, all of these programs had to learn about Harm Reduction, and we were the only people doing it. So, we did enormous amounts of training, and staff development, organizational consulting, to help people change their agencies from 'not' Harm Reduction friendly to Harm Reduction friendly. So, which includes things like, "OK, you now have a policy that says you have to be 30 days clean and sober in order to get services here," that's no longer allowed. So, you can no longer have that policy, now what are you going to do?

Dr. Van Nuys: Yeah.

Dr. Denning: So, as we developed more and more organizational consultation, as well as more clinical training, we were invited into more and more agencies in San Francisco. Then, people started saying, "Well, how about you do some direct service with our clients?" So, we now have therapy teams that we train. We have a two year Post-Masters or a Post-Doc training program in Harm Reduction Therapy. We train the therapists, and then in addition to working in the private practice model, we place them in a small Harm Reduction Therapy Center clinic in the community.

So, like at Tenderloin Health in San Francisco, which is one of the largest social service drop-in organizations, they see sometimes up to 300 people a day in the drop-in community center. We have a Harm Reduction Center team there with three or four therapists, a supervisor, a part-time doctor, and part-time psychiatric nurse practitioner.

So, we do medications, we do therapy, for the most disorganized and chaotic folks in San Francisco, mostly seriously mentally ill, active drug use, serious medical problems, and we do most of it on a drop-in basis. It's exactly the same method that we use in our private practice.

Dr. Van Nuys: Now, are you doing any kind of research to help document the effectiveness of this?

Dr. Denning: Yeah, yeah we are. That was something that was really important to me at the beginning, it's unfortunately because of funding and admin time has not gotten off as well as possible. I formed a research advisory team for us, and we came up with a research protocol that includes five different measures, outcome measures, that indicate increased motivation for change, increased changes, and decreased specific harms, and have all the measures in the packet. We give those to every new client who comes in. And then, we are supposed to do them every six months thereafter. And it's that second part that we've being having trouble administratively getting. We now have a volunteer research assistant, who is going to start getting those second and third batches in and start doing some data analysis.

We did a quick and dirty, an archival, data collection about, I think, four years ago - I am not sure. And what we found was pretty astonishing. Well, first of all we labeled drug use a little differently than is in the manual. We talked about recreational use, maintenance use which could be a person who is actually dependent on alcohol, but they are using it in a regular kind of way and it's not interfering much with their life, but they are still using way too much in term of medical consequences.

And then, we also had a category called chaotic, which means just really out of control, suffering a lot of harms, having no success in moderating or quitting their use. Just really out of control.

And then we listed from a chart review three drugs that a person might be using. We listed a maximum of three. Drug number one, which is the client self identified major problem. And then, drug two, which seemed secondary and drug three. And we did the outcomes on just the use of those drugs. And the amazing thing that we found is that almost half of people who had a chaotic drug use were abstinent from that drug at the end of treatment.

Dr. Van Nuys: Interesting.

Dr. Denning: It's amazing.

Dr. Van Nuys: Yeah, it is.

Dr. Denning: Given that, nobody came to us saying that they want to quit drugs. They all came saying they were hoping to moderate or whatever. But, up to 50% had decided on their own - well, with our help - that the best harm reduction strategy for them at least from that number one chaotic drug of choice was abstinence.

Dr. Van Nuys: OK. So, how hopeful or optimistic are you about this approach spreading to other parts of the country?

Dr. Denning: You know, I am very optimistic about it at this point. I am working with an organization in Boston. We are working with large organizations in Chicago that are redoing their entire programs over to harm reduction. And these are agencies that include a lot of social services, housing, supportive housing, case management as well as treatment, mostly residential treatment. And they have embraced the idea. And they are just really needing those clinical training and the organization development to do that. And it's been really wonderful to work with folks, because, when you think about individual therapy, there's a lot that you can do in individual therapy that is very creative. Hopefully, is to the better of your client. It's not hurting anybody else.

But, when you talk about residential, when you talk about people living in community, how then do you do harm reduction in a way that you can respect both the individual and the community?

So, if you are not going to kick people out for active drug use. How do you take care of other people who are in the facility who want to abstinent and are upset by somebody's use?

Dr. Van Nuys: Ah-ha.

Dr. Denning: So we do a lot of training about what's the meaning of craving and triggers. How there are wonderful treatment approaches, absolutely successful approaches to use to help people manage triggers and cravings.

Dr. Van Nuys: Well, this is all very inspirational I must say. I am glad to hear that these kinds of alternatives are out there. We probably should begin to wind down here.

Dr. Denning: OK.

Dr. Van Nuys: Where can listeners get more information on harm reduction?

Dr. Denning: Well, you can certainly go to our website, which is, harmreductiontherapy.org. And we have a lot of resources listed there. And we also have - well my original book is there - but there is also a lay person's version called "Over the Influence". And that's a book that Jeannie Little and I and a colleague wrote in - let's see now - 2004 I believe it came out. And it's basically taken the clinical model and has explained it for the general public. So, that you can use it as a self use book, or you can use it as just a way to begin thinking about your own use or thinking about somebody in your family. There's a chapter in that book 'Over the Influence' for family members. And how family members can use harm reduction for themselves when they are dealing with a loved one's drug addiction.

There is also a whole section on drugs. Pretty much every drug we could imagine and how it's used. And why people use it. What are the greatest harms that are associated with it and how you can begin to reduce the harm if you choose to keep using it. So, it's everything from alcohol to ketamine to iowaska to heroin.

Dr. Van Nuys: OK. well, that sounds like a wonderful resource.

Dr. Denning: Yeah. And there are lots of resources. There are websites in the back of that book "Over the Influence." There are resources all around the country - lots for reading, yeah.

Dr. Van Nuys: Excellent. Well, Dr. Patt Denning, thanks so much for being my guest today on Wise Counsel.

Dr. Denning: You are welcome. Thank you very much.

[musical interlude]

Dr. Van Nuys: I hope you learned as much I did from this conversation with Dr. Patt Denning. Her approach makes a lot of sense to me. The US spends a huge amount of money keeping substance abusers behind bars. I am wondering if there is any chance that the current fiscal crisis might drive a change in the political winds regarding substance use and abuse. It's not a question I got around to posing in the interview, but that might be one bit of silver lining to emerge from our financial mess. One can hope. You've been listening to Wise Counsel, a podcast interview series sponsored by mentalhelp.net. If you found today's show interesting, we encourage you to visit mentalhelp.net. Where you can add a comment or a question to this shows web page, view other shows in this series or simply page through the site which is full of interesting mental health and wellness content.

Access this show's page and show archive information via the podcast box on the mentalhelp.net home page. If you like Wise Counsel, you might also like Shrink Rap Radio my other interview podcast series, which is available online at www.shrinkrapradio.com. And rap is spelled R-A-P. Until next time, this is Dr. David Van Nuys and you've been listening to Wise Counsel.