Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice

Summary & key facts

This paper presents PHRI, a way for mental health workers to support people who use or are thinking about using psychedelics. PHRI mixes harm-reduction therapy (which focuses on safety and reducing risks) with ideas from psychedelic-assisted therapy. It is meant to work across different mental health problems and in short or long therapy sessions. The model asks clinicians to be non-judgmental, to assess and prepare people carefully, and to help them deal with difficult experiences. The authors say this approach is timely because more people and some medical systems are talking about and allowing psychedelic use.

Key facts:

• PHRI stands for Psychedelic Harm Reduction and Integration and is a clinical approach for people who use or consider using psychedelics.
• The model is described as transtheoretical, meaning it borrows useful methods from several types of therapy rather than sticking to just one.
• PHRI is transdiagnostic, which means it is designed to help people with many different mental health problems, not only one specific diagnosis.
• PHRI combines harm reduction psychotherapy, which focuses on safety and reducing harm, with elements from psychedelic-assisted psychotherapy.
• The approach can be used in brief single sessions or in ongoing therapy over weeks or months.
• PHRI shifts away from treating psychedelic use only as a problem that must end and instead promotes a compassionate, non-stigmatizing stance toward patients' choices.
• The paper gives practical guidance for assessing people, preparing them before psychedelic experiences, and supporting them through difficult or challenging experiences afterward.
• The authors argue the model is timely because public discussion, changes in law enforcement priorities, and some medical approvals have increased interest in psychedelic use and care.

Abstract

Psychedelic Harm Reduction and Integration (PHRI) is a transtheoretical and transdiagnostic clinical approach to working with patients who are using or considering using psychedelics in any context. The ongoing discussion of psychedelics in academic research and mainstream media, coupled with recent law enforcement deprioritization of psychedelics and compassionate use approvals for psychedelic-assisted therapy, make this model exceedingly timely. Given the prevalence of psychedelic use, the therapeutic potential of psychedelics, and the unique cultural and historical context in which psychedelics are placed, it is important that mental health providers have an understanding of the unique motivations, experiences, and needs of people who use them. PHRI incorporates elements of harm reduction psychotherapy and psychedelic-assisted psychotherapy, and can be applied in both brief and ongoing psychotherapy interactions. PHRI represents a shift away from assessment limited to untoward outcomes of psychedelic use and abstinence-based addiction treatment paradigms and toward a stance of compassionate, destigmatizing acceptance of patients' choices. Considerations for assessment, preparation, and working with difficult experiences are presented.

Topics

Chemical synthesis and alkaloids Neurotransmitter Receptor Influence on Behavior Psychedelics and Drug Studies

Categories

Clinical Psychology Psychology Social Sciences

Tags

Abstinence Addiction Behavior change Biology Context (archaeology) Harm Harm reduction Mainstream Medicine Mental health Nursing Paleontology Philosophy Psychiatry Psychology Psychotherapist Public health Social psychology Theology Transtheoretical model

Substances

Ayahuasca Ketamine LSD MDMA Psilocybin

Conditions & symptoms

Addiction Anxiety Depression PTSD Substance abuse disorder Addiction or harmful habbits Anxiety or worry Feeling disconnected from others Sadness or low mood