Harm Reduction. G. Alan Marlatt , Ph.D. University of Washington Addictive Behaviors Research Center [email protected] http://depts.washington.edu/abrc/. Harm Reduction: History. U.K. Model Medicalization Approach Netherlands Normalization Approach Junkie bond. Dutch Model.
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G. Alan Marlatt, Ph.D.
University of Washington
Addictive Behaviors Research Center
“Habit is habit and not to be flung out of the window by any man, but coaxed downstairs a step at a time.”
Pudd’nhead Wilson’s Calendar,
How was I supposed to know that the apple was a controlled substance?
Spectrum of Intervention Response
Thresholds for Action
Social Norms and
the Prevention of
Alcohol Misuse in
H. WESLEY PERKINS, PH.D.
Department of Anthropology and Sociology, Hobart and William Smith Colleges, Geneva, New York 14456
Peak Blood Alcohol Concentration
ProjectBrief Alcohol Screening and Intervention for College Students
G. Alan Marlatt, Ph.D
John S. Baer, Ph.D.
Daniel R. Kivlahan, Ph.D.
Lori Quigley, Ph.D.
Mary E. Larimer, Ph.D.
Sally Weatherford, Ph.D.
Dan Irvine, BS
Ken Weingardt, MS
Lisa Roberts, MA
Lizza Miller, BA
Jason Kilmer, MS
Linda Dimeff, MS
Research Study Assistant
Graduate Research Assistant
The National Institute of Alcohol Abuse and Alcoholism
Grant # 5R37-AA05591
Stages of Change Intervention Strategies
Assessment & Treatment Matching
Precontemplation a Contemplation a Preparation a Action a Maintenance a Relapse
Motivational Enhancement Strategies
Relapse Prevention & Relapse Management
Prevalence of Alcohol-Related Consequences Among Fraternity and Sorority Members
50.0%Neglected your responsibilities
47.8%Missed a day (or part of a day) of school or work
41.7%Not able to do your homework or study for a test
40.0%Got into fights, acted bad, or did mean things
39.2%Felt you needed more alcohol . . . to get same effect
38.9%Caused shame or embarrassment to someone
36.8%Had a fight, an argument or bad feelings with a friend
36.6%Drove shortly after having more than two drinks
33.7%Noticed a change in your personality
24.2%Missed out on things . . . spent too much . . . on alcohol
21.9%Drove shortly after drinking more than four drinks
16.2%Went to work or school high or drunk
16.1%Felt that you had a problem with alcohol
8.1%Felt physically or psychologically dependent
7.9%Felt you were going crazy
7.5%Had withdrawal symptoms
Freshman Year of University
Spring Autumn Winter Spring Autumn
Quarter Quarter Quarter Quarter Quarter
- 11 clinical cases
- 7 late responders
- 348 randomized for intervention
174 – High-risk control
174 – High-risk intervention
- 115 agreed to participate
(overlap of 26 with high-risk group)
AlcoholQuantity (6pt)All points
Daily Drinking QuestionnaireBaseline & FU
Alcohol NegativeRutgers Alcohol Problem Index (RAPI)All points
ConsequencesAlcohol Dependence ScaleBaseline& FU
DSM IIIr Dependency Scale (SCID)Baseline & FU
Collateral ReportQuantity, Frequency, & ProblemsBaseline & FU
Blood Alcohol Concentration*as a Function of Drinks Consumedand Time Taken to Consume
Number of Hours
Number of Drinks
* for a MALE, 185 lbs.
Frequency of Alcohol Consumptionfrom High School to College
Four Year Outcome ResultsDrinking Problems
Four Year Outcome ResultsDrinking Rates
- Avoids Labels
- Avoids Rules
-Treats young people as adults
-Tolerates “illegal” activity
-Tailored to personal history
-Tailored to risk status
The Three Dangerous Drives in Adolescent Motivation
Drinking Dating Driving
Are YOU are Harm Reduction therapist?
Are YOU are Harm Reduction therapist?
If you answered Yes to all five questions, then you ARE a harm Reduction Therapist, and we would like to invite you to join your colleagues as a member of the Association for Harm Reduction Therapy (AHRT)!