HarmReductionApproachesrelatedtoAddiction

JoseHernandezDubon,B.S.
CounselorIntern
September1,2015

Definingaddictionisonethemostcontroversialanddebatedconceptsinthefieldsof
mentalhealthandsubstanceabuse.Sussman&Sussman(2011)tookaqualitativeapproachthat
summarizesthemostcommonlyagreedonelementsofaddictionanddiscussesphilosophical
concernsregardingnecessaryandsufficientconditionsforapsychologicalstateorpatternof
behaviortobeanaddiction.Furthermore,delineationofitsdefinitionalelementsmaybeastep
towardeventuallyachievingconsensusandoperationalizationofthisconstruct(Sussman&
Sussman,2013).Recentcriteriadevelopmentasevidencedinthenewesteditionofthe
DiagnosticandStatisticalManualofMentalDisorders(5thed.DSM5AmericanPsychiatric
Association,2013)substanceusedisordercombinestheDSMIVcategoriesofsubstanceabuse
andsubstancedependenceintoasingledisordermeasuredonacontinuumfrommildtosevere.
Whereasadiagnosisofsubstanceabusepreviouslyrequiredonlyonesymptom,mildsubstance
usedisorderinDSM5requirestwotothreesymptomsfromalistof11.Drugcravingwillbe
addedtothelist,andproblemswithlawenforcementwillbeeliminatedbecauseofcultural
considerationsthatmakethecriteriadifficulttoapplyinternationally(APA,2013).
ArecentdefinitionofaddictionhasbeenproposedandexaminedbytheAmerican
SocietyofAddictionmedicine(ASAM).AccordingtoASAMaddictioncriteriaischaracterized
byinabilitytoconsistentlyabstain,impairmentonbehavioralcontrol,cravingorincreased
hungerfordrugsorrewardingexperiences,diminishedrecognitionofsignificantproblemswith

onesbehaviorandinterpersonalrelationships,andadysfunctionalemotionalresponse(Caracci
&Drago,2013).Manyarticlesaboutharmreductionhavebeenpublishedascounselorsand
physiciansareoftenusingholisticapproachesinordertoincreaseretentionratesamongclients
andpatients.Recently,controlledsubstancessuchasVyvanseandothermedicationoftenusedto
treatADD,ADHDhavebeenplacedonhandsofspecificallytrainedprofessionalsinorderto
avoidoverprescriptionandmanyconditionsthatmayhaveimplicationsinanindividuals
learningcapacityhavebeengrantedtomedicalpsychologistsorpsychiatristsinorderto
appropriatelyservethatparticularpopulation(
Puzantian
,T,2014).
Oneofthepossiblebenefitsofthisturnaroundmayinvolveactiveparticipationfromtheclient
oncetheyhavemadeaninformeddecisiontoinitiatechange.Severalapproachestocounseling
workingwithclientsexperiencingsubstanceabuseorevenmildsubstanceusearenowaiming
towardsharmreductioninterventionsinordertofacilitateservicesasanalternativeforthose
whobenefitmostfromindividualsessions.Italsomayprovideawindowforthosetryingto
workonselfcontrol,medicationmanagement,aswellascompulsivetendenciesalongwithother
challengesthatclientsmaybewillingtoworkonaspartoftherapysessions.
Alongwithsubstanceuse,anurgeforrewardingexperiencesmayalsobeconsideredaddictive
behavior.Casinoworkers,asanexampleoftenfacesituationsinwhichtheyexperience
psychologicaldisturbancessuchasgamblingissuesandsecondhandsmokewhichmaybe
consideredforrelapsepreventionandsmokecessationinterventions(Suzanetal.,2015).


References
AmericanPsychiatricAssociation.(2013).Substancerelatedandaddictivedisorders
.

Diagnostic
andstatisticalmanualofmentaldisorders
(5thed.).
doi:10.1176/appi.books.9780890425596.744053
Burton,Suzan,etal."Smokingisbad,it'snotcoolyetI'mstilldoingit:Cuesfortobacco
consumptioninadarkmarket."
JournalofBusinessResearch
(2015).
Caraci,F.,&Drago,F.(2013).NewDefinitionofAddictionproposedbytheAmericanSociety
ofAddictionMedicine:Whichimplicationsforthetreatmentoftobaccodependence?.
EuropeanNeuropsychology,2014,(24),issue1,14.DOI:
http://dx.doi.org/10.1016/j.euroneuro.2013.05.003
Puzantian,T.(2014).Vyvanse:ALookatAmericasMostPrescribedStimulant.
TheCarlat
ChildPsychiatryReport,2014,Vol5,
6
.retrievedon2015083117:03
SussmanS.,&Sussman,A.N.(2011)
ConsideringtheDefinitionofAddiction.Int.J.Environ.
Res.PublicHealth

2011
,
8
(10),40254038doi:
10.3390/ijerph810402
5