Addiction Professional shines a light on Scott Kellogg and his Gradualism model. I’ve mentioned him several times in this blog and he has been kind enough to link to me on his website.

Two months ago Kellogg established a website ( that he hopes will serve as a vehicle for discussion around a more nuanced approach to treatment. He says that after he began using the term “gradualism,” he noticed that practitioners in non-abstinence based initiatives in Europe in the 1970s had used the term “gradual change” to describe what they were trying to instill in persons with substance use problems.

A Gestalt-trained therapist, Kellogg holds some views that seem to place him closer to the harm reductionist’s way of looking at substance use and recovery. He questions treatment center practices that appear to profess abstinence at the risk of losing many clients before they can start making progress. He states his belief that “there’s a crisis in our treatment world because many people don’t like treatment.”

Yet he also says his perspective goes against the tenets held by many harm reductionists. He is most impatient with the attitude in some needle exchange programs and similar initiatives that “we would never tell people what to do.” Offering a shower, a sandwich and a clean needle and then repeating the process time and again are fine in the short term, but at some point you need to help build a life after you’ve saved one, he suggests.

3 thoughts on “Gradualism

  1. Thanks for the post.Interesting the reductionist way vs the treatment facility. Personally I don't know that I could cut back and hold it truthful. I mean I could cut back from time to time, but then it always just came back with a vengence. Treatment works if the addict wants to work on recovery


  2. I believe that you'r experience would be the experience of other addicts as loss of control is the nature of addiction. To me, the point of this kind of approach is to build relationships, increase motivation to recover and extend a hand until they are ready to pursue recovery.


  3. I'm a great fan of Gestalt therapy; I ought to be, I've done enough of it and there are pearls to be found in this approach, particularly in helping motivation and readiness.I heard the great alcoholism researcher George Vaillant speak on a trip I made to the US a year or two back. He pointed out that in his long term (and I mean very long term) cohort study of Harvard Graduates, 26 alcoholics had thousands of hours of therapy between them. It was not associated with recovery.AA membership on the other hand was strongly associated with recovery. This is tough for me as I'm a big fan of psychotherapy as I say.I think the practice of throwing people out of treatment for having symptoms of the illness they are suffering from (using substances) is not necessarily a good one. We reviewed our practice in the centre I work in and began taking more 'risks' with clients who lapsed in treatment. We now have many examples of people maintaining recovery who might otherwise have been lost to treatment and may have been more likely to go back to chaotic addiction. The centre didn't collapse nor the therapeutic community dissolve into chaos.So I guess my take on this is that there is wisdom here for us, but I'll temper it with evidence and experience too.


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