Mandated Treatment for Troubled Adolescents and Substance Use Disorder: Identifying and Breaking Through Defensiveness and Denial

*Corresponding author: Nelson J. Tiburcio*, Scarlett L. Baker and Kristin S. Kimmell

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brief research report

Abstract

Objective
This article presents an investigation of the defensiveness demonstrated by teens who are mandated to participate in treatment as compared to their non-mandated peers.
Methods
The data for this study was collected as part of The Substance Abuse Subtle Screening Inventory (SASSI) Institute’s third iteration of the Adolescent SASSI-A3. A total of 164 teenagers in treatment served as the dataset for the present study. All participant cases were provided by clinicians working in service settings throughout all U.S. Census Regions and serving in a variety of venues including substance use treatment, criminal justice programs, community corrections, private clinical practices, behavioral health centers, and social service organizations.
Results
We present two brief de-identified treatment case studies, aptly demonstrating defensiveness and denial from a clinical standpoint. Additionally, we review cases demonstrating high-levels of defensiveness and denial in mandated teen clients, and ethical ways to break through that barrier to treatment engagement.
Conclusion
Working with teens can be extremely difficult given their rapid mood changes, intensely felt experiences and shifting states of compliance, openness and defiance. When teens are mandated for treatment, they may often feel their choices have been taken away and the counselor may be viewed as more of a power authority rather than a concerned and helping figure. Contingencies
placed on the teen as part of the mandated treatment experience are generally the primary focus, rather than addressing their underlying substance use disorder (SUD). As a result, the teen, as well as the counselor, require greater focus than just making sure those requirements are met.
Keywords
Mandated treatment; Adolescent addiction; SASSI-A3; Defensiveness; Denial; Teen drug use.