Essay:What are reasons for resistance to treatment for alcohol abuse?
The client is engaged, cooperative and refusing one half of the treatment. That is a different clinical problem from refusal, and the reasons and the steps both have to reflect it.
Editorial process
Last reviewed · August 22, 2026
Partial engagement is not refusal
Notice the shape of the scenario before choosing your two reasons. This client is engaged, attending, willing to take medication and willing to do psychotherapy. They are not resisting treatment; they are declining one component of it while accepting the rest. That distinction changes everything downstream, because the leverage a counsellor normally lacks with a refusing client is already present here: there is a relationship, a shared goal and regular contact. Any answer that reaches for confrontation or for making treatment conditional on abstinence is discarding that leverage. Say that in the first line, because the two questions that follow both change once you have. The reasons you offer should explain why someone who came for help would decline half of it, and the steps should be ones that only work with a client who is already sitting in front of you rather than avoiding the appointment.
For the two reasons, choose ones that differ in kind rather than two versions of denial. The brief points at social, employment and family influences and each supplies something distinct. The client may not meet their own stereotype of a person with a drinking problem, especially if they are employed and functioning. Their drinking may be normal within their social or occupational group, so the comparison is with peers rather than with guidance. They may be using alcohol to manage the depression they have agreed to treat, which makes giving it up feel like removing the thing keeping them upright. For the steps, work with the engagement you have: use the depression treatment as the entry, ask permission before offering information, use decisional balance rather than argument, monitor the interaction between alcohol and the antidepressant as a clinical rather than a moral matter, and set a shared measure the client can observe themselves.
Likely learning objectives
- Distinguish partial engagement from refusal of treatment.
- Identify reasons for resistance that differ in kind.
- Use the accepted treatment component as leverage for the declined one.
- Apply motivational rather than confrontational steps.
Assignment instructions
Read the full question
Review every instruction before using the planning guidance that follows.
Treating clients with co-occurring disorders can be very challenging. One of the challenges often encountered in a therapeutic setting is resistance. For a variety of reasons, a client may resist treatment. Even if they are seeing you for services, they may or may not acknowledge they need help for either mental health or substance use related issues. For the purposes of this discussion, imagine that you have a client who is experiencing depression and who also needs treatment for excessive alcohol use. The client freely accepts that depression is an issue and is willing to take medication and engage in psychotherapy. However, the client fails to see that their drinking pattern is maladaptive and is not willing to address the drinking issue, only the depression. Respond to the following prompts: What reasons can you think of that might lead this client to be resistant to treatment for alcohol abuse? Identify two reasons (utilize your text and/or other resources to assist you in identifying possible reasons; you may also review potential influences in areas of a person’s life including social, employment, family etc.). What steps can you take to address this resistance? There are many models/theories to work with resistance.
Course-wide instructions that accompany this question
You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.
Turn the brief into deliverables
- 01A recognition that this client is partially engaged rather than refusing.
- 02Two reasons for the resistance, from different domains.
- 03At least one reason drawn from social, employment or family influence.
- 04Steps that work with the client's existing engagement.
- 05A clinical rather than moral framing of the alcohol and antidepressant interaction.
- 06A shared measure or observation the client can make themselves.
Two reasons, then steps that fit a cooperative client
What kind of resistance this is
Establish that the client is engaged and declining one component.
What the assessor is likely looking for
An explicit distinction between partial engagement and refusal.
Reason one: how they see themselves
Explain identity, stereotype and functioning as a barrier to recognition.
What the assessor is likely looking for
A reason located in self-concept rather than in denial.
Reason two: the world around them
Use social, occupational or family norms as the comparison the client is making.
What the assessor is likely looking for
A named influence such as a workplace drinking culture.
Working with the engagement you have
Describe permission-seeking, decisional balance and using the depression treatment.
What the assessor is likely looking for
A step that would fail with a disengaged client and works here.
Making the connection observable
Propose a shared measure that lets the client see the interaction themselves.
What the assessor is likely looking for
A measure the client collects rather than one you report to them.
Where the engagement evidence is published
Recommended databases
- NCBI Bookshelf
- NIAAA
- PubMed Central
- University Library
Search sequence
- 1.Read a motivational interviewing source before proposing any step.
- 2.Look up the interaction between alcohol and antidepressant treatment response.
- 3.Search for evidence on engagement in co-occurring disorder treatment.
- 4.Find something on stigma as a barrier to help-seeking for alcohol use.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Motivational Interviewing
StatPearls, NCBI Bookshelf · 2024
Motivational interviewing, for the stance and the specific techniques.
Stages of Change Theory
StatPearls, NCBI Bookshelf · 2023
Stages of change, for locating this client and choosing the matched intervention.
Common Comorbidities with Substance Use Disorders Research Report
National Institute on Drug Abuse, via NCBI Bookshelf · 2020
Comorbidity evidence, for why the two conditions maintain each other.
Understanding Alcohol Use Disorder
National Institute on Alcohol Abuse and Alcoholism · 2024
Alcohol use disorder, for the maladaptive pattern the client does not recognise.
Chapter 6—Co-Occurring Disorders Among Special Populations
SAMHSA, via NCBI Bookshelf · 2020
Co-occurring disorders in special populations, for social and occupational influences.
Before you post to this forum
Common mistakes
- Treating the client as refusing treatment when they are attending and cooperating.
- Giving two reasons that are both forms of denial.
- Proposing confrontation, which discards the engagement already present.
- Making continued treatment conditional on addressing the drinking.
- Ignoring that the alcohol may be managing the depression being treated.
Submission checklist
- Have you noted that the client accepts half the treatment?
- Do your two reasons come from different domains?
- Do your steps use the existing relationship rather than pressure?
- Is the interaction framed clinically rather than morally?
- Have you cited a source for the approach you propose?
Use this guide to plan and review your own work. Follow your institution's rules and read Brinevia's academic-integrity policy.
Written by
Maren Caldwell
MSN, RN, CNE
Medical-surgical nursing, pharmacology and NCLEX preparation
Maren is a registered nurse with over 15 years of clinical and educational experience in medical-surgical nursing. She writes on NCLEX preparation, patient care fundamentals, pharmacology and evidence-based practice.
Reviewed by
Dr. Tessa Redmond
DNP, RN, CNE
Evidence-based practice and clinical education
Tessa is a doctorally-prepared nurse educator. She reviews Brinevia content for clinical accuracy and alignment with current evidence-based guidelines.