Interview: Cyndi Turner discusses two opposing models in addiction treatment
Is abstinence always required in the treatment of alcohol and drug use problems? Some experts say no. Although the traditional model of treatment says that people must be abstinent to recover fully from a substance use disorders (SUDs), other treatment models such as harm reduction say that people with problematic alcohol use can learn to drink in moderation without requiring them to be completely abstinent.
Cyndi Turner, LCSW, LSATP, MAC, co-founder and clinical director of Insight Into Action Therapy and a treating clinician at the National Football League (NFL), was a guest speaker on the Feb. 5 “In Your Right Mind” radio show called, “Abstinence vs. Harm Reduction,” which compared the traditional disease model and harm reduction model in addiction treatment. We asked Turner to discuss these alternative viewpoints, including the main principles of harm reduction and how it compares to the traditional abstinence-based model of addiction treatment.
Question: Do you think abstinence always works for people with substance use disorders?
Answer: Abstinence does not work for everyone with SUDs. We now look at SUDs on a spectrum ranging from mild to severe. Only people who are on the severe end of the spectrum tend to be physically dependent and need to stop using completely. Regarding alcohol use, only 6 percent of the population is severe enough to be called alcoholic. A much larger percentage — 22 percent or about 90 million people – are struggling with a mild to moderate alcohol use disorder, yet the majority of treatment is geared for people who are severe. The less severe people often go without treatment because they are afraid of being stigmatized as an alcoholic or forced into going to treatment, having to attend AA meetings and giving up their drinking completely. There is another type of harm reduction treatment that may be better for them: alcohol moderation.
Q: What is harm reduction?
A: Alcohol moderation helps people understand WHY they are drinking and teaches them coping skills. It is appropriate for people who are willing to monitor the amount and frequency of their drinking, and who have not experienced withdrawals or multiple blackouts. The Dietary Guidelines for Americans recommends no more than two drinks a day for men and no more than one for women and older adults. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) allows more – no more than three drinks a day up to seven a week for women and no more than four a day up to 14 a week for men. I have found that the NIAAA’s definition is more risky because most people are starting to feel alcohol’s effects by three drinks and may find it hard to use judgment to stop.
Q: How does harm reduction differ from an abstinence-based treatment approach?
A: The traditional approach for addiction treatment has been complete abstinence from all nonprescription, mood-altering substances combined with 12-step meetings like Alcoholics Anonymous (AA). Harm reduction treatment is for people who are unwilling or unable to stop their chemical use. It is an individualized approach that works to reduce the negative consequences of substance use.
Q: When would harm reduction, rather than abstinence, be more appropriate?
A: As I mentioned, harm reduction is appropriate for those experiencing a mild or moderate alcohol use disorder. I consider it successful when people are able to cut down their drinking, utilize healthier ways to deal with their emotions and live a more balanced life. Harm reduction also works well when people are not ready to address their substance use. If someone comes to therapy and I ask them to stop using their primary coping skill without giving them other tools or understanding what else is going on in their life, they are not going to come back. As a therapist, it’s my job to take the person where they are, explore their resistance and give them options rather than tell them what to do.
Q: What are some of the pros and cons of harm reduction?
A: Practicing harm reduction is hard! Chronic substance use has significant legal, familial, interpersonal and physical health consequences. Sometimes it is easier, and at times, lifesaving to be completely abstinent. But I would rather keep a therapeutic dialogue going than force my recommendations on someone. If that person does not come back to my office, I can’t help them at all.
About Cyndi Turner, LCSW, LSATP, MAC
Cyndi Turner is a licensed clinical social worker, substance abuse treatment practitioner and master addiction counselor who has more than 20 years of experience. She is the co-founder and clinical director of Insight Into Action Therapy. She co-developed and facilitates the Dual Diagnosis Recovery Program, and provides expert witness testimony, clinical supervision for licensure and therapy for players involved with the National Football League’s (NFL) Program for Substances of Abuse. Turner challenges the traditional belief that all drinkers experiencing problems are alcoholics who need to quit drinking forever. She is a moderation management-friendly therapist who is certified in Get SMART FAST. She lives in Northern Virginia. Her new book, “Can I Keep Drinking? How You Can Decide When Enough is Enough,” challenges the traditional treatment models for alcohol use problems.