Substance use reduction in the context of outpatient psychiatric treatment: a collaborative, motivational, harm reduction approach.

A conceptual model for reducing substance use within the context of outpatient psychiatric treatment is described. The proposed model incorporates four themes from the psychological treatment literature: treatment intensity, stages of change, motivational interventions, and harm reduction. The five steps of the model include (1) establishing a working alliance, (2) evaluating the cost-benefit ratio of continued substance use, (3) individualizing goals for change, (4) building an environment and lifestyle supportive of abstinence, and (5) anticipating and coping with crises. This model attempts to integrate clinical realities of mental health treatment with empirically-grounded strategies applicable to substance abuse problems.