Mental health articles

Th ere are two basic models for treatment, harm reduction and abstinence. Both have their place. Sometimes a student may fi rst try to reduce harm by curbing drinking, only to discover later that complete abstinence is necessary.
Harm Reduction Approaches
Most college students are not initially interested in abstaining and so may hesitate to discuss their substance abuse problems with a counselor for fear that the automatic response will be “Stop using.” In contrast to abstinence-based treatment, harm reduction may appeal because it lets students choose treatment
goals . Th e harm reduction approach holds
that alcohol and other drugs are neither inherently good nor bad. Th e role of
clinicians is to help students identify how much harm they experience from
using and what steps they will take to reduce the harm.
Consider the example of a student who is brought before a dean for disciplinary action because aft er consuming 22 beers he caused residence hall damage and got into a fi ght. Careful review of his situation reveals that he typically consumes 15+ beers per drinking event. Rather than focusing on
abstinence or diagnosis, a clinician using a harm reduction approach might
ask the student, “What changes would you need to make to avoid getting
in trouble with the dean again?” Th e student answers, “I need to keep my
consumption to no more than 12 beers.” Th ough perhaps privately groaning
with skepticism, the clinician would reinforce the student’s response
because it represents movement in the right direction and thus reduces
harm. Plans are then made to keep track of consumption and to meet regularly
to assess the outcome. In all likelihood, the student will still run into
trouble, but further trouble presents a good opportunity for consideration
of new goals. In this way, the student defi nes and buys into the changes that
are needed.

Abstinence-Based Approaches
Most inpatient and intensive outpatient programs (IOPs) hold that alcoholism
and chemical dependency are best conceptualized as a disease.
Based on the work of Jellinek (1960), the “disease model” argues that the
goal of treatment should be abstinence from all mood-altering substances.
While there are cogent arguments against the disease model (Peele, 1989;
Peele, Brodsky, & Arnold, 1991), it is also true that some students truly are
dependent on alcohol and cannot safely drink. In our experience, students
at times need to try and fail at moderation strategies before choosing abstinence
as the goal that is right for them. Indeed, Larimer et al. (1998) found
that people trained in controlled drinking eventually had increased rates
of abstinence. Th us for some students, the end result of the harm reduction
approach is to discover the need for abstinence. When students come to
this realization, they are more open to the traditional treatment supports of
12-step recovery (AA and Narcotics Anonymous [NA]). College clinicians
can help students make this discovery and fi nd resources to support them
in maintaining sobriety.
In our view, college mental health programs should provide or collaborate
with a range of treatment providers, from those who support moderation to
those who off er traditional abstinence-based approaches. Clinicians should be
open-minded in assessing a student’s substance abuse problems and motivation
for treatment, tailoring an approach appropriate for the individual.