Integrative Therapy for Addiction and Compulsion A Harm Reduction Approach

Andrew Tatarsky, Ph.D.

Andrew has worked with people who struggle with drugs and their families for over 40 years. He developed Integrative Harm Reduction Psychotherapy (IHRP), a model that integrates relational psychoanalysis, CBT, and mindfulness within a harm reduction framework. IHRP supports clients in discovering their truth and choosing goals and strategies that best fit their unique journeys toward positive change. His work is described in Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems-translated into Polish, Spanish, and Russian-and in numerous published papers. He holds a doctorate in clinical psychology from the City University of New York and completed postdoctoral training at NYU’s Program in Psychoanalysis and Psychotherapy. Andrew maintains a private practice in NYC, offering therapy, training, and consultation.

He is a Senior Advisor at Silver Hill New York, where he provides supervision and training in harm reduction-informed care, and he formerly founded and led the Center for Optimal Living. He also serves on the Medical and Clinical Advisory Panels for the New York State Office of Addiction Services and Support. Andrew has trained professionals and organizations in 20 countries, with a focus on advancing a re-humanized, compassionate approach to problematic substance use and expanding access to care across the harm reduction spectrum.

This training introduces Integrative Harm Reduction Psychotherapy (IHRP) as a revolutionary “psychobiosocial” paradigm shift from traditional abstinence-only models toward a social justice-oriented framework. The curriculum begins by exploring the limitations of the current addiction field and the dominant disease model, transitioning into a re-humanized understanding of high-risk behavior as a meaningful response to trauma and social dislocation. Participants will learn the “Nine Therapeutic Tasks”, which include techniques for creating a safe relational container, enhancing self-regulation through mindfulness-based “Urge Surfing”, and utilizing “Assessment as Treatment” to facilitate a client’s self-discovery. By integrating cognitive-behavioral strategies with psychodynamic insights, the course equips practitioners to work with clients at all stages of change and collaboratively develop “Optimal Use Plans” that prioritize “any positive change” over mandatory sobriety.

Integrative Therapy for Addiction and Compulsion:
A Harm Reduction Approach
Agenda

Module 1: The Scientific Revolution in Addiction Treatment (The Paradigm Shift in Addiction Treatment) (1 hr 15 min – pre-recorded)

In this foundational module, you’ll explore why the dominant narratives around addiction, like the disease model and abstinence-only treatment, fall short for so many clients. You’ll be introduced to a harm reduction framework that centers compassion, meaning, and collaboration, setting the stage for a more effective therapeutic approach.

• Overview of IHRP Training-Welcome to IHRP: A New Paradigm in Treating Addiction (19 min)
• My Journey (18 min)
• Tom’s Story (8 min)
• Why we need a Scientific Revolution in the Addiction Field (7 min)
• Dominant Narratives about Substance Users and Addiction (23 min)
• The Solution: The New Paradigm (6 min)

Module 2: Harm Reduction: From Public Health to Psychotherapy (1 hr 37 min – pre-recorded)

This module provides a deep dive into the core principles of harm reduction and how they translate into therapy. You’ll learn how harm reduction evolved from public health into a full-spectrum clinical framework that welcomes clients without judgment and supports them in making meaningful, client-defined changes.

• Harm Reduction Definitions (10 min)
• Public Health Applications of Harm Reduction (25 min)
• Substance Use Management (11 min)
• The Language of Harm Reduction (17 min)
• Harm Reduction Principles as Therapeutic Frame (15 min)
• Need for an Integrative Approach (6 min)
• Overview of the Nine Therapeutic Tasks (13 min)

Module 3: Why Harm Reduction is Essential to Effective Helping: Clinical Rationale and Theoretical Support (2 hr 23 min – pre-recorded)

In this module, you’ll explore the psychobiosocial roots of substance use and addictive behavior, including trauma, disconnection, shame, and social marginalization. You’ll also learn how to engage clients who are ambivalent about change and not ready to stop.

• Case Vignettes: Peter/Sara (15 min)
• Realities of people who struggle with problematic and addictive behavior (18 min)
• Theoretical Shift: From Disease to Psychobiosocial/Multiple Meanings Model (19 min)
• The Multiple Meanings of Risky Behavior (12 min)
• High Risk Behaviors from Pain (14 min)
• Common Relational Issues Related to Substance Use (16 min)
• Trauma and Problematic Substance Use (15 min)
• Learning, Neuroplasticity, Behavior and Habit (15 min)
• Social context, social determinants, Social Dislocation Theory (7 min)
• The Psychobiosocial Process Model (12 min)

Module 4: Creating a Safe Relational Container (1 hr 14 min – pre-recorded)  

This module focuses on the relational heart of harm reduction therapy: creating a safe, nonjudgmental container that allows clients to explore their behaviors without fear of shame or rejection. You’ll learn how to manage alliance ruptures, offer corrective experiences, and use the relationship itself as a healing agent.

• The Importance of Therapeutic Alliance (14 min)
• Harm Reduction Creates safety and alliance (27 min)
• Harm Reduction Engagement Skills (8 min)
• Relationship Heals (13 min)
• Harm Reduction Facilitates the Corrective Emotional Experience (12 min)

Module 5: Self-Regulation and Assessment (1 hr 57 min – pre-recorded)

Addictive urges are often treated as something to be suppressed or controlled, but in this module, you’ll learn how to use them as powerful entry points for transformation. You’ll explore how to bring mindful attention to urges, decode their meaning, and support clients in building new behavioral pathways.

• Enhancing Self-Regulation (38 min)
• The Urge is the Axis of Change (24 min)
• Urge Surfing Demonstration (9 min)
• Assessment as Treatment (15 min)
• Microanalysis (19 min)
• Unwrapping the Urge (12 min)

Module 6: Action Planning for Positive Change (2hr 22 min – pre-recorded)

In this module, you’ll move from insight to action. You’ll learn how to help clients develop personalized, harm-reduction-based goals that reflect their lived reality, not someone else’s idea of success. You’ll also explore techniques for supporting change without coercion, working skillfully with ambivalence, and creating “optimal use plans” that reduce harm while building momentum toward healing.

• Embracing Ambivalence (21 min)
• Techniques for Embracing Ambivalence (18 min)
• Case Vignette: Valerie (13 min)
• Harm Reduction Goal Setting (13 min)
• Personalized Planning for Change: The Ideal Use Plan (14 min)
• More Strategies (42 min)
• Case Vignette: Sara (24 min)

Module 7: The Inner Work: Countertransference and Therapist Self- Awareness (1 hr 17 min – pre-recorded)

The final module turns inward to focus on you, the therapist. Working with addiction, compulsion, and high-risk behaviors often stirs strong emotional reactions, sometimes consciously, sometimes not. In this module, you’ll explore how to recognize, manage, and learn from your countertransference, so you can remain present, compassionate, and ethically grounded in your work.

• Countertransference in Working with Addiction (18 min)
• Experiential exercises for Working with Countertransferrence (18 min)
• Countertransference Management Strategies (21 min)
• Further Suggestions (12 min)
• Take-Aways (8 min)

Integrative Therapy for Addiction and Compulsion
A Harm Reduction Approach
Learning Objectives

1. Contrast the dominant disease model narratives with the proposed integrative “new paradigm” for treating addiction.
2. Analyze the scope of the substance use problem in the US, including recent drug overdose and poisoning statistics.
3. Identify at least three limitations of traditional specialty addiction treatment effectiveness.
4. Identify two core components of the “Scientific Revolution” needed in the addiction field to move beyond traditional treatment models.
5. Describe the “psychobiosocial” model and how it differs from a reductionistic view of addiction.
6. List the four distinct parts of the harm reduction movement in the United States.
7. Identify three evidence-based public health harm reduction interventions, such as MOUD or syringe service providers.
8. Describe the concept of “Compassionate Pragmatism” as a therapeutic frame.
9. Differentiate between “traditional” and “harm reduction” clinical language to reduce treatment trauma
10. Analyze the relationship between Adverse Childhood Experiences (ACEs) and the risk for intravenous drug abuse.
11. Describe the “Window of Tolerance” and one physiological sign of each of the HyperArousal and HypoArousal zones.
12. Identify the “Multiple Meanings Model” and how high-risk behavior can be used as a “language” for patients.
13. Explain the “Stages of Change” theory and its relevance to selecting appropriate clinical interventions.
14. Name two reasons why 90% of traditional treatment programs may fail to engage the majority of substance users based on their stage of change.
15. Identify the “therapeutic alliance” as a primary predictor of success in substance abuse treatment.
16. Explain the “Microanalysis” technique for unwrapping the triggers and consequences of a typical pattern of use.
17. Identify at least three categories of interventions used in IHRP action planning.
18. Formulate an “Ideal Use Plan” (Optimal Use Plan) that balances benefit with risk for a client not seeking abstinence.
19. Utilize a “Decisional Balance” tool to help clients explore ambivalence regarding their current use patterns.
20. Identify two common countertransference reactions when working with high-risk behaviors and strategies for managing therapist subjectivity.

The course is designed for beginning/introductory health care practitioners.

To receive the 12 Distance Learning/Home Study continuing education credits, applicants must complete all course materials, purchase the CEs, submit an evaluation form, and pass a post-test with a score of 80% or greater. It is the responsibility of the attendee to determine if the CE credit offered by Academy of Therapy Wisdom meets the regulations of their state licensing/certification board.

Continuing Education credits offered:

Psychology: Not offered with this training.

NY State Mental Health Counselors: Academy of Therapy Wisdom is recognized by the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors. #MHC-0285.

This course is $497. You can purchase it here.

We offer a 14 day money back guarantee on all of our live & on-demand courses. If you find that the training is not right for you, please email us at support@therapywisdom.com within 14 days of your purchase. You can request a full refund or exchange, whichever you would prefer.