The Confrontational Method for Treating Substance Abuse

Illustration of two facesThere are many different forms of counseling techniques that clinicians will learn throughout their training and years of experience. Whether a therapist will choose to implement one technique over another is based on that person’s comfort level, experience, and preference. The question that counselors often ask themselves is whether a particular therapeutic approach meets the individual needs of the person in therapy.

A technique that is occasionally implemented with people recovering from substance abuse is confrontational counseling. In this approach, the therapist confronts a person on his or her behavior, attitude, and beliefs. The purpose of this technique is to the person take ownership for their behavior, and it urges them to be honest with themselves and their environment. This approach may be seen as being unfair and overly abrupt. At times, this technique works for people who need someone to make them personally responsible for their lies or other detrimental behavior. This is especially beneficial for people who are lying and trying to justify their behavior (i.e., usually it is their substance use they are trying to justify).

At times, this approach can be brutally honest, which can cause people to feel defensive and believe they are being judged. If the confrontational approach is not used in the context of a soft tone, it can come across as being biased. When dealing with substance abuse, the ultimate question for the therapist is what method of counseling will best meet the needs of the client. If a person is relapsing and using illicit substances, he or she will need to be confronted about the negative behavior. These people need to comprehend that their behavior can cause harm to them and that they are hurting the people around them. But does that mean they should not figure this out on their own? Should the therapist guide them through the path of self-realization?

Often in counseling programs, we therapists are taught to be sympathetic and understanding and nurture people toward the goal of self-realization of their mental health issues. The confrontational method is really the opposite of what many therapists are taught. The confrontational approach usually results in instructing people about what they are doing, telling them how they should be acting to correct the negative behavior, and making judgments about them. It leaves no room for softness, empathy, and understanding. Sometimes people may become confused because they do not understand the point of confrontation, while other times they may be appreciative.

This is not to say that the confrontational method is not an effective method to use for individuals who are struggling with substance abuse. This method is useful for people who want someone to be honest with them and tell them about their behavior and show them that they are not being truthful. This method seems to work with individuals who are looking to be confronted so that they can come to terms with the reality of their substance use. The confrontational method is not good for individuals who are looking to work through their issues and wanting to come to the conclusion of substance use on their own. The individual who is looking for an unbiased method and softer tone also would not seek this type of therapy. Whatever method is implemented, it is strongly recommended that therapists recognize the strengths of their training and carefully consider what method a person will respond to positively.

Related articles:
What Is Recovery?
Identifying and Treating Addiction and Substance Abuse Problems
Do I Really Have a Drinking Problem?

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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Dot


    June 1st, 2012 at 2:39 PM

    With most addicts I have known confrontation isn’t going to get you too far. Most of them get very defensive very quickly and will back away from treatment when they feel like they are cornered.

  • Vickie


    June 2nd, 2012 at 6:56 AM

    What good is confrontation when there are so many more effective ways to talk to people?
    Confrontation can feels os demeaning to most people, especially if it is not doneby someone who is trained in this method or in an environment where the addict can feel safe.
    I am just not sure that with all of the different modes of therapy that are avilable if this is the one that I would choose to use on a regular basis.
    Yes, there will be those one or two people who will probably respond well. But overall I think that there are better ways to go about this.

  • JLipackCounseling


    June 2nd, 2012 at 8:15 AM

    This is an article about one method that some therapists use or agencies use. This was an unbiased perspective explaining the method, as well as going with the pros and cons. Whether one client may or may not like it is up to the individual. This is not to say ALL therapists use this. There are times this method has worked, and the client did not respond well to the therapist who used a different approach.

  • quinn


    June 2nd, 2012 at 2:22 PM

    You know, I can see how for some addicts this could be the only thing that hits home for them. Too many times they have only been surrounded by their enablers, those who say the things and do the things for them that only supports their habit. They might not be buying the drugs and alcohol, but by enabling them they are giving them permission to continue their ruinous behavior. But when someone really stands up and confronts them, shows them that they DO NOT support their actions and will not continue to enable them if they saty on this road of addiction, then maybe that is the slap in the face that some of them need to change their ways. It might work and it might not. A good therapist will be able to see if this is making a difference in a good way, and if it isn’t her or she will not be afraid to try something different until they find the thing that will reach them and help them make that connection to sobriety.

  • W.Brown


    June 2nd, 2012 at 7:15 PM

    It must be hard doing that-trying to figure out to what the client will respond positively.because people into substance abuse can be picky and moody and they may exhibit swinging behavior and it can become very hard to predict what would be the right technique in such a scenario.

  • alec


    June 3rd, 2012 at 8:39 AM

    Why would you think that an addict like me might respond well to someone confronting me? I know that you don’t want to hold my hand, but confrontation I don’t need.

  • Geoffrey F.

    Geoffrey F.

    May 28th, 2016 at 3:05 AM

    Dear Alec,
    The fact that you say what you don’t need shows that you need it. To be confronted by what you are doing is not only usful with addictions but in every walk of life. I do it naturally when I see the difference between what a person say and what they do… I describel what they are doing. What you have to look at/see is… No matter what we think, we are not what we think about ourselves we are only what others see. Right or wrong, like it or not. Our main problem is that we think we are only what we think and we are afraid of confrontation to that “system” “Habit”… All we do is make excuses give reasons and tell stories. Also, if you think getting straight will make life “Better” you are wrong… It will only make you straight and you may/will live longer. Life is not fun. I was lucky to live through to 60s in NYc and may have experienced the best times from 1950 to 1980 in The Village.

    Try this: Cut back, smaok grass and drink a little to “Feel Good” and get off anything “Hard” get away from the others who do it. Taper of, from high to “normal” and see what you can do to make a better life for yourself.

  • Max


    June 4th, 2012 at 4:24 AM

    Have you given any thoughts, Alec, what method of intervention would help, or are you just not ready to go there yet?

  • alec


    June 4th, 2012 at 3:33 PM

    Max- I honestly don’t know. There is a part of me who thinks about getting straight and how much better life would probably be without all of the drugs and crap. But then, I don’t know. I think that in the end I am scared to live without them. I have always had this crutch, for way longer than I haven’t. And it’s kind of scary to give that up, understand? I know that’s being a coward, but it is what it is. I have tried going straight and it did not work. I never felt any better, so it kind of gets to where you wonder the point of all the trying is.

  • blake green

    blake green

    June 5th, 2012 at 3:58 PM

    A confrontational method to me only sets the addict up to be defensive.
    I think that we all know that going on the defensive is not the best route to take for recovery.

  • Geoffrey F

    Geoffrey F

    June 27th, 2016 at 7:15 AM

    The confrontational method doesn’t have to be obvious. It only means to show the person something about what they do/are doing that is not “Good” for them or others around them. First, I would ask: What do you want to do in 5 years. Where ywould you like to be, with who? and work towards these goals with them but, always showing them what they are doing that stops/avoids these self proclaimed goals. Show them that they aer self-saboteurs and find a way to get them to work for themselves, not against themselves.

  • Zakari A.

    Zakari A.

    June 25th, 2016 at 11:53 PM

    Thanks for the post, its interesting. But I want to know the steps to follow using confrontation approach to counsel vandalizers

  • Geoffrey F

    Geoffrey F

    June 27th, 2016 at 7:12 AM

    It is because other methods may not work. How do you get someone to stop doing something that, in
    some way, “Works” for them. One why is to show how it doesn’t work any more… About vandalizers. There are two ways: One is to joint them and set up a situation and lead them away from it. Another way is to vandalize them or show their mother getting vandalized. A bit of a shock. The main reason people do anything is to get attention and/or a sense of control over life or others. I would consider making them the leader in a group. They should lead the meeting, speak to the people who attend with a speech… it can all be a set-up with prepared text and… Like the x-junky way, get them to council younger people who do the same, vandelize. Try these methods and let me know.

  • Kenneth A

    Kenneth A

    December 26th, 2016 at 11:08 PM

    Notice that the author fails to cite one single scientific study demonstrating the effectiveness of confrontational counseling. This is because the science has proven that confrontation has worse outcomes than no treatment at all. Just Google William White and William Miller’s review of the evidence.

  • Geoffrey F.

    Geoffrey F.

    December 30th, 2016 at 2:05 PM

    Yes, you can always be right if you only quote “Science” when it is all under the scientific eye and scientific methods to deal with a more complex/human way of living with this “Outlook Problem”. Confronattion can work and save a lot of Scientific time and money.

  • Geoffrey F

    Geoffrey F

    December 28th, 2016 at 2:41 AM

    I did not invent the term, “Confrontational”. I said, in my comments… As part of a
    good relationship and a way to get many people out of depression and … I said I was for confronting them with what they do/say and how they act to others and how thay can have a more satisfied form of life. I was not speaking as a scientist, but as a person with experience. Each case is different. Do I need a scientific study to say that? It is the main issue, the symptoms and the resolutions that are similar with
    other, standard methods.

  • Jairo W

    Jairo W

    March 30th, 2017 at 12:49 PM

    Wow, where is coming from, the Medieval Book of Spells? This sort of reactive attack therapy might be based on the “therapist” common sense but has no foundation in science or the greatness of spirit that distinguishes real healing approaches. Most people with addiction disorders often have limited access to rational executive functions and will definitely NOT think themselves out of their addiction; not to say they are not aware of the consequences of their actions, but blame, judgement and guilt are NEVER therapeutic!

  • Camryn E

    Camryn E

    April 14th, 2018 at 9:00 PM

    I was an abused kid put into a rehab that used “attack therapy.” Its was incredibly damaging. It was absolutely abusive. I grew up and had a career in counseling. Had i done ANYTHING like this to a patient, i would have been fired and criminally prosecuted for abuse. Anyone using this “method” should be stripped of thier license and jailed. If you have to resort to abuse, you have no skills.

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