In this episode — Dr. Andrew Tatarsky, developer of Integrative Harm Reduction Psychotherapy, returns for a second conversation. They take up the question that divides the field, whether a person who once drank a fifth a day can ever have a drink on a Saturday night. Andrew: some can, some can’t, we don’t yet have the science to tell which, and the therapist’s job is to help each person answer it for themselves. Also: the “submit–rebel bind” abstinence-first treatment sets up, an 89-year-old client who cut her drinking in three sessions, addiction as a continuum that includes junk food and the phone in your hand, and harm reduction as the container for psychedelic-assisted therapy.

Guest: Dr. Andrew Tatarsky — clinical psychologist and psychoanalyst, New York; PhD in Clinical Psychology; postdoctoral certificate in psychotherapy and psychoanalysis (NYU); developer of Integrative Harm Reduction Psychotherapy (IHRP); more than 40 years in practice; author of Harm Reduction Psychotherapy: A New Treatment for Drug and Alcohol Problems. andrewtatarsky.com · About · Training · Book

Nothing in this conversation is medical advice.

Chapters

00:00 — Cold open: addiction as a universal human response to suffering

00:54 — Welcome: the case for community

02:20 — Two harm reduction stories: a call from the White House, and a two-page letter at NPR

05:41 — The acting drug czar who changed his mind

08:31 — What harm reduction is: the disease model, the drug war, and the AIDS crisis

11:15 — From public health to psychotherapy: compassionate pragmatism, start where people are

14:29 — Religion and the law: clean or using, no gray

16:27 — Can a person who drank a fifth a day ever have a drink on a Saturday night?

17:25 — Taught the disease model in the eighties, and in the sixties: Jellinek’s chart

19:09 — An alternative paradigm: addiction as a response to suffering

20:36 — Who can moderate and who can’t: we don’t have the science

22:46 — Why this is a courageous position: impulse control disorders

25:18 — Drinking, driving, skiing: the bad-driver analogy

27:13 — The submit–rebel bind

29:16 — An 89-year-old who wanted to cut back her drinking

31:43 — Alcohol at 87: the finest fuel

33:09 — Addiction on a continuum: junk food, phones, relational meaning

36:25 — Gambling, eating, shopping, sex

38:04 — Psychedelics and harm reduction: ketamine, ibogaine, a New York training

41:06 — Close