Here’s What I Wish I’d Said on My Recent Podcast Episode

alcohol treatment familiesIn early May, I was in Phoenix for the annual symposium for therapists who treat individuals struggling with problematic sexual behaviors and their partners. I was presenting on harm reduction at the conference on a panel discussing alternative paths of recovery that may not include 12-step recovery groups. I was thrilled to bring harm reduction to the field of sexual addiction and recovery.


While I was there, I spoke further with Jackie Pack, the facilitator of our panel. She invited me onto her podcast Thanks for Sharing to talk more about harm reduction. A couple of weeks ago, Jackie graciously hosted me and we talked about harm reduction, its benefits and rationale, and how it can help those struggling with addictive behavior and those who love them.


We covered a lot of ground, but there are some things we didn’t get to or that I wish I’d said more clearly. Here’s the rundown.


How Harm Reduction Can Help Families

If a family member or someone you love is struggling with a substance use or sexual behaviors that are out of control, chances are you’ve tried to talk to them about getting help.


Usually, this doesn’t go very well and for a number of reasons. The individual may not be ready to change, the person may not feel in control of their own decisions, or in desperation and (often) exasperation, the family members issue an ultimatum that’s flatly rejected.


It’s such a familiar cycle to so many families. Here’s how it goes:

  1. Some sort of crisis occurs with the out-of-control loved one: He returns to using or acting out, he gets into trouble with the law, he loses his job because of their behavior, etc.
  2. The family, out of great concern, strongly urges him to go to treatment. “We can’t deal with this anymore,” they might say. “You have to get your shit together.”
  3. The struggling individual, now in a “one-down position” because of the crisis, feels ashamed and submissive. That is, he “agrees” to go to treatment because he feels he really can’t say no after the crisis and what it’s put his family through.
  4. He goes to treatment and completes a program successfully or drops out, leaving against medical advice. (This is part of the reason why the success rates in 12-step programs are so low and the recidivism rate is proportionately high.)
  5. Rinse and repeat. The loved one’s return to use often escalates the situation, so that the family’s “tough love” gets tougher. As their response ups the ante, the loved one responds by acquiescing at first, only to return to more risky and dangerous relapses later. The cycle of relapses continues.


This is the tragedy that so many families live with. But there’s a better way. I began to talk about this a bit in the podcast, but I got sidetracked.


What if families and the loved ones could collaborate together, being partners in seeking mutual support instead of being caught in an endless cycle of controlling, nagging, and threatening, and rebelling and relapsing?


By meeting the loved one struggling with their use where they are and providing psychoeducation to families about the process of change, among other interventions, harm reduction can:

  • Identify and transform harmful interactional patterns
  • Help families lovingly set boundaries and limits
  • Clarify how substance use is embedded in the family life and relationships
  • Create a collaborative environment
  • Assist each family member in identifying means of self-care
  • Increase the loved one’s motivation for positive change
  • Transform not just the substance use but the family’s relationships as well


To learn more about this approach, check out Dr. Robert Meyers’ book Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening. I think that harm reduction can also greatly benefit those families struggling with the aftermath of sexual addiction, though as I mentioned in the podcast, some changes to the approach may be appropriate. Here’s what I mean.


Harm Reduction and Sex Addiction

Though it was developed as a means to treat substance use, harm reduction can be helpful with problematic sexual behaviors, as I’ve discussed elsewhere. I think it’s useful in a number of ways.


First, as I mention in the podcast episode, the current sex addiction treatment model is a top-down (i.e., cognitive), task-based approach. That is, do the things and you should get better (and here, of course, I grossly oversimplify to make a point). But studies on the outcomes of therapy tell us that therapy really works only when there’s a solid relationship between the client and the therapist. Harm reduction embraces this, seeing the therapeutic relationship as the axis of change.


Second, harm reduction can greatly help partners who are struggling as their loved one may have a “slip” or a relapse, returning to problematic sexual behaviors. Rather than see this as a failure, harm reduction can see this as a normal part of change, which can mitigate the relational damage that may otherwise be caused. Accountability is still a must, and reparations for these boundary violations are very necessary, of course.


Third, harm reduction can help those recovering from addictive sexual behaviors and their partners analyze difficult, conflictual interactions and find new ways of relating. Harm reduction excels at scrutinizing behavioral patterns that contribute to addictive behavior. This same process of microanalysis can be extraordinarily helpful in clarifying destructive interactional patterns, setting boundaries without being punitive, and establishing mutual support.


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Jeremy Mast

Jeremy is a licensed marriage and family therapist (CA LMFT90961) in private practice in Ventura, California. He helps those struggling with drugs, alcohol, and out-of-control sexual behaviors awaken to new possibilities for their lives. He lives with his wife, son, and cat in beautiful southern California.

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