Demonstrating that traditional approaches to addictions fall short for many substance abusers with psychological problems, this book shows how effective therapeutic work can be conducted with clients still using alcohol or other drugs. For the first time, the goals and methods of harm reduction are incorporated into a comprehensive psychotherapeutic approach--one that can be initiated without waiting for, or insisting on, abstinence. Clinicians learn concrete strategies for assessing the client's personality, behaviors, and resources; enhancing motivation for change; making collaborative treatment decisions; and implementing a range of different interventions.