Resistance in Treatment

Resistance is generally defined as client opposition or ambivalence to treatment or refusal to participate in treatment. Clients may exhibit resistant behavior for various reasons including but not limited to a client's own motivation, program inflexibility, the level of counselor competence, or poor provider-client communication. Resistance can be tied to a client's belief that treatment for substance use disorders necessitates a loss of personal freedom or that substance use disorder treatment does not work. Whatever the reason for the behavior, resistance is an expected component of treatment that providers will inevitably have to address.

It is important that practitioners address resistance in some way because studies have shown that if resistance persists, it can prevent full client engagement and may lead to a client's early exit from treatment, both of which can and do lead to poorer outcomes than if a client were fully engaged and remained in treatment for a professionally recommended length of time. This finding does not imply that clients who are coerced into treatment will not be successful in treatment. In fact, studies by John Kelly and colleagues, Douglas Young and colleagues, Steven Belenko, and many others indicate that clients who are coerced into treatment have the same or better outcomes compared with those who have not been coerced. This finding is an especially important point as more correctional systems embrace mandatory treatment instead of incarceration for individuals who commit substance-use-related crimes. However, research conducted by Robert Shearer and colleagues indicated that at least 25% of inmates screened for substance use do not enter treatment due to motivational factors and that resistance tends to be higher among individuals in the correctional setting, especially among ethnic and cultural minorities within the correctional setting. With growing concern about increasing prison populations and studies indicating the effectiveness of in-prison substance use disorder treatment in reducing subsequent crime and costs to society, resistance is a prominent obstacle providers must assist individuals in overcoming in order for treatment to be maximally effective. These concerns hold true even outside the correctional setting when cultural, racial, and ethnic factors form the basis for powerful feelings of resistance to treatment among members of minority communities. Fortunately, there are many therapeutic options providers can use to deal with resistance in treatment.