I have chosen to discuss Dr. Rothschild's paper from the standpoint of the exceptions to when a clinician can correctly (i.e., ethically) blend harm reduction with any of the modern approaches to psychoanalysis, including relational psychoanalysis, when treating substance abusers. In addition, I will discuss some inherent pitfalls to conceptualizing aspects of the addicted person in terms of dichotomies, e.g., high/not high, and the idea that the substance abuser is dissociated versus aware when choosing to use.

Before beginning that discussion, I would like to thank Dr. Debra Rothschild for taking on a serious and courageous examination of the controversial applicability of harm reduction, in its pure form, for working psychotherapeutically with substance abusers. Secondly, she should be praised for her meaningful attempt to blend relational psychoanalysis with harm reduction as a potentially successful model and approach for working with substance abuse and addiction.