When a loved one seems to fight every suggestion, skip appointments, or sabotage their own progress, it is easy to feel hopeless. Clinicians may label it non‑compliance, and families may call it denial, stubbornness, or lack of willpower, but what looks like resistance from the outside is almost always a complex, protective response on the inside, especially when co‑occurring substance use and mental health conditions are involved.
Resistance, however, is almost never the problem; it’s usually the best solution the person has identified up to that point, and understanding what is actually happening underneath the behavior changes everything. It allows clinicians and families to move from blaming the individual to collaborating with them, going from power struggles to partnership, and shifting from frustration to identifying a clearer path forward.
“Resistance” as Protection, Not Personality
In treatment settings, resistance is often used as a shorthand for arguing, avoiding, missing sessions, or refusing recommendations. However, motivational interviewing reframes this as a natural response when someone experiences pressure to change faster than they feel ready, safe, or able to do so.
Seen this way, resistance isn’t simply difficulty for the sake of it; it’s information.
- A client who shuts down when the conversation turns to trauma may be protecting themselves from overwhelming memories they have never had the skills or support to face.
- A young adult who minimizes their substance use may be desperately trying to hold onto the only coping mechanism that has ever reliably numbed their anxiety or shame.
- A parent who argues with every treatment plan may be terrified of repeating past experiences where systems failed their child.
When treatment teams and families interpret these behaviors as willful opposition, they often escalate pressure. It can lead to more ultimatums, more confrontation, and more scrutiny, which can intensify the very fear and shame that fuel the “resistance” in the first place.
The Impact of Trauma and Co‑Occurring Disorders
For many people with substance use disorders, there is a direct link between trauma, chronic stress, and the development of addiction. Youth and adults with trauma histories are significantly more likely to struggle with substances, and those with post‑traumatic stress often find it harder to stop using because trauma reminders can trigger powerful cravings.
From the outside, this can look like someone choosing substances over treatment; however, on the inside, several things may be happening:
- The nervous system is chronically activated. Hypervigilance, dissociation, or shutdown can make traditional talk therapy or group settings feel unsafe or intolerable.
- Substances or compulsive behaviors have become central tools for emotional regulation. Asking someone to stop using without offering other ways to manage trauma-related distress can feel unbearable.
- Co‑occurring depression, anxiety, or other psychiatric conditions sap motivation, concentration, and hope, making it hard to trust that any treatment could help.
People with this profile are also more likely to disengage from care completely or to struggle to engage consistently. What appears as resistance is often a sign that trauma and mental health symptoms have not been adequately addressed in the treatment plan.
Readiness to Change: Why Pushing Harder Backfires
Another key piece is timing. Many individuals enter treatment due to court mandates, family pressure, school requirements, or workplace demands. They may not yet agree that change is necessary, or they may feel ambivalent and pulled between wanting relief and fearing what life will look like without their current coping patterns.
The transtheoretical model (often used in motivational interviewing) describes stages of change: from not yet considering change, to ambivalence, preparation, action, and maintenance. A person in the early stages may:
- Minimize consequences.
- Emphasize what substances or symptoms “do for them.”
- Test limits to see if others will really follow through.
If treatment assumes they are already in the action stage, the mismatch shows up as resistance. In motivational interviewing, this is a cue for the clinician to slow down, explore ambivalence, and align with the person’s own values, rather than pushing harder for immediate behavioral change.
When the System Looks “Resistant” to the Person
It is important to note that treatment environments themselves can contribute to apparent resistance. For individuals with complex trauma, neurodivergence, or marginalized identities, certain settings or approaches may feel unsafe or invalidating, including:
- Confrontational or shaming group dynamics.
- Lack of cultural, racial, or gender sensitivity.
- Staff who minimize trauma or frame all distress as “manipulation.”
- Policies that require full abstinence before trauma-focused therapy, even when substances are being used to manage overwhelming symptoms.
Leaving, shutting down, or refusing to engage can sometimes be a healthy protest against care that feels misattuned or even re‑traumatizing. In these cases, the question is not, “Why is this person resisting treatment?” but “What in this treatment setting is failing to meet this person’s needs?”
The Role of Family Systems
No one exists in isolation. Family Systems Theory reminds us that when one member struggles, the entire family system is affected, which, in turn, shapes the individual’s behavior.
Patterns such as secrecy, over-functioning caregivers, parent–child role reversals, chronic conflict, or emotional cut‑offs can all impact how someone presents in treatment. For example:
- A teen who appears disengaged in therapy may be caught in an unspoken family rule that problems must be handled privately, not with “outsiders.”
- A parent who dismisses the seriousness of their own drinking may inadvertently undermine a young adult’s motivation to address their addiction.
- Family members who alternate between rescuing and punishing can reinforce the belief that treatment is just another arena where the person will be shamed or controlled.
Research consistently shows that involving families in treatment improves engagement, outcomes, and long‑term recovery, particularly for adolescents and young adults. When families do the work alongside their loved one, for example, through psychoeducation, family therapy, and their own support, resistance often softens on all sides.
What Clinicians Can Do Differently
For clinicians working with individuals who appear resistant, several shifts can be powerful:
- Reframe resistance as information: Instead of asking, “How do I break this resistance?” ask, “What is this behavior protecting, and what does it tell me about this person’s history and current environment?”
- Prioritize safety and regulation: Build in grounding skills, sensory regulation, and predictable structure before and alongside deeper trauma processing, especially with co‑occurring disorders.
- Use motivational interviewing and collaborative language: Explore ambivalence without judgment. Emphasize autonomy and shared decision‑making.
- Assess and treat trauma and mental health concurrently with substance use: Trauma‑informed, dual‑diagnosis capable care is essential; treating one in isolation from the other often fuels relapse or disengagement.
- Integrate the family system where appropriate: Offer family therapy, psychoeducation, and caregiver support, as changing long‑standing patterns can be as important as individual work.
- Stay curious rather than reactive: When there are missed sessions, relapse, or conflict, approach these as opportunities to understand what is not yet working in the plan rather than as evidence that the person doesn’t want it.
How Families Can Respond When a Loved One Seems “Resistant”
Families often carry enormous fear, grief, and exhaustion by the time they reach treatment, so it is understandable they want quick, visible change. Yet, some of the most effective family responses are both firm and compassionate, including:
- Separating the person from the behavior: Hold clear boundaries around safety while remembering that substance use and symptoms are often attempts to survive unbearable internal states, not personal attacks.
- Learning about trauma, addiction, and co‑occurring disorders: Psychoeducation helps families understand why change is so difficult and what realistic progress looks like.
- Engaging in your own support: Family therapy, support groups, and individual counseling for caregivers reduce isolation and help shift patterns that may unknowingly maintain the status quo.
- Avoiding extremes of rescuing or rejecting: Consistent, boundaried care, rather than cycles of crisis, rescue, and burnout, creates a more stable environment for change.
- Asking treatment providers about their approach: Is the program trauma‑informed? Does it address co‑occurring mental health and addiction? How are families included? These questions help ensure that resistance is not being used to mask a poor fit.
From Resistance to Relationship
When people appear resistant to treatment, something important is happening. Their nervous system, history, and relational world are speaking, even if the words sound like “No,” “This won’t work,” or silence.
For clinicians, recognizing the true meaning behind resistance allows a shift to occur, from confrontation and imposing change to collaboration and willing commitment to change. For families, it offers a way to stay engaged without taking every setback as a personal rejection or moral failure.
Most importantly, reframing resistance as protection creates room for hope. If resistance is a strategy, not a fixed trait, then with safety, time, and the right support, new strategies can emerge. Underneath even the most entrenched “no” is often a deep longing: to feel safe, to belong, and to believe that healing is possible.
Sources:
- Substance Abuse and Mental Health Services Administration. (2018). Chapter 3—Motivational Interviewing as a Counseling Style.[ncbi.nlm.nih]
- National Governors Association. (2025). Addressing the Link Between Trauma and Addiction.[nga]
- National Child Traumatic Stress Network. (n.d.). Making the Connection: Trauma and Substance Abuse.[nctsn]
- Recovery First. (2025). Motivational Interviewing: 6 Stages of Change.[recoveryfirst]
- Mental Health Academy. (2025). Using motivational interviewing to address client resistance. Mental Health Academy.[mentalhealthacademy+1]
- Recovery Research Institute. (2025). Involving family members in substance use disorder treatment.[recoveryanswers]
- Lindsey, M. A., et al. (2021). Family involvement in treatment and recovery for substance use disorders.[pmc.ncbi.nlm.nih]
- SAMHSA. (2020). The Importance of Family Therapy in Substance Use Disorder Treatment.[library.samhsa]
- National Institute on Drug Abuse. (2025). Trauma and Stress.[nida.nih]
- Hall, K., et al. (n.d.). Motivational interviewing techniques.[mcgill]
