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Resistance in Adolescent Substance Abuse Treatment: A Literature Synthesis

NCJ Number
Journal of Social Work Practice in the Addictions Volume: 7 Issue: 3 Dated: 2007 Pages: 5-28
Debra E. Orr-Brown; Darcy Clay Siebert
Date Published
24 pages
This comprehensive analysis of recent literature on adolescent substance abuse treatment highlights strategies used to handle adolescents' resistance to treatment.
After reviewing various concepts of resistance proposed in the literature, the author concludes that an integrative framework for defining resistance offers the best approach for examining resistance to treatment. Arkowitz (2002), for example, suggests combining the common elements of various conceptions of resistance under the term "ambivalence." Ambivalence occurs when clients believe that change will improve their lives and have progressed so far as to identify strategies for implementing new behaviors; however, this is accompanied by a vacillation between adopting and avoiding the tasks necessary to achieve new behaviors. After discussing the conception of resistance to treatment, this article reviews substance abuse treatment methods used with adolescents. These include various family therapies and individual and group therapies. The author concludes that most of the treatment methods currently used with adolescent substance abusers do not adequately incorporate interventions specifically designed to reduce resistance. The author notes, however, that motivational interviewing (MI) is a treatment method designed to assist therapists in working with clients to address resistance to treatment. MI, as defined by Miller (1996), is "a directive client-centered counseling approach for initiating behavior change by helping clients resolve ambivalence." This approach is designed to address client resistance by requiring the therapist to view resistance as ambivalence and to structure responses to resistance so that the client addresses his/her ambivalence constructively. Research on MI outcomes have found that its use improves client engagement in the therapeutic process and reduces substance abuse. 48 references