Harm reduction Harm Reduction Pragmatic Strategies for Managing High-Risk Behaviors SECOND EDITION Edited by G. Alan Marlatt Mary E. Larimer Katie Witkiewitz tHe GuiLFord PreSS NEW YORK LONDON © 2012 The Guilford Press A Division of Guilford Publications, Inc. 72 Spring Street, New York, NY 10012 www.guilford.com All rights reserved No part of this book may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher. Printed in the United States of America This book is printed on acid-free paper. Last digit is print number: 9 8 7 6 5 4 3 2 1 The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the authors, nor the editors and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources. Library of Congress Cataloging-in-Publication Data Harm reduction : pragmatic strategies for managing high-risk behaviors / edited by G. Alan Marlatt, Mary E. Larimer, Katie Witkiewitz. — 2nd ed. p. cm. Includes bibliographical references and index. ISBN 978-1-4625-0256-1 (hardcover) 1. Substance abuse—Complications—Prevention. 2. Substance abuse—Treatment. 3. Health behavior—Social aspects. 4. Harm reduction. I. Marlatt, G. Alan. II. Larimer, Mary E. III. Witkiewitz, Katie. RC564.H364 2012 362.29—dc23 2011026409 In memory of G. Alan Marlatt His generosity, compassion, and brilliance championed the harm reduction movement and touched the lives of so many people worldwide. We express our sincerest gratitude to Alan for his gentle spirit and his extraordinary ability to accept us exactly as we are. We miss him terribly. about the editors G. Alan Marlatt, PhD, until his death in 2011, was Director of the Addic- tive Behaviors Research Center and Professor of Psychology at the Univer- sity of Washington. For over 30 years, Dr. Marlatt conducted pioneering work on understanding and preventing relapse in substance abuse treat- ment and was a leading proponent of the harm reduction approach to treat- ing addictive behaviors. Mary E. Larimer, PhD, is Professor of Psychiatry and Behavioral Sciences and Adjunct Professor of Psychology at the University of Washington, where she is also Associate Director of the Addictive Behaviors Research Center and Director of the Center for the Study of Health and Risk Behaviors. Katie Witkiewitz, PhD, is Assistant Professor of Psychology at Washington State University Vancouver. In August 2012 she will be joining the faculty of the Department of Psychology at the University of New Mexico, with a joint appointment at the Center on Alcoholism, Substance Abuse, and Addictions. vii contributors Michele Peake Andrasik, PhD, Fred Hutchinson Cancer Research Center and Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington Paul L. Bergen, MSc, Populi Health Institute, Edmonton, Alberta, Canada Arthur W. Blume, PhD, Department of Psychology, Washington State University, Vancouver, Washington Seema L. Clifasefi, PhD, Addictive Behaviors Research Center, University of Washington, Seattle, Washington Susan E. Collins, PhD, Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, Seattle, Washington Jessica M. Cronce, PhD, Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington Patt Denning, PhD, Harm Reduction Therapy Center, San Francisco, California Tiara M. Dillworth, PhD, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington William H. George, PhD, Department of Psychology, University of Washington, Seattle, Washington Karyn K. Heavner, PhD, Populi Health Institute, Wayne, Pennsylvania Scott B. Hunt, MA, School of Psychology, Fielding Graduate University, Santa Barbara, California Scott Kellogg, PhD, Schema Therapy Institute and Department of Psychology, New York University, New York, New York ix