Rethinking confrontation in alcohol and drug treatment: consideration of the clinical context.

The role of confrontation in the treatment of substance misuse problems is widely debated in the field. Historically, confrontation of denial has been important in treatment, particularly in residential programs. However, confrontation has also been criticized as counterproductive. Miller et al. colleagues have found that confrontation from treatment professionals is correlated with poor outcome. This paper reviews the literature supporting and criticizing confrontation. It is suggested that confrontation is not a monolithic concept. Rather, it is contingent upon clinical contextual factors that current research has not addressed, such as the treatment setting, treatment philosophy, client characteristics, the client's view about their relationship with confronter, the extent to which the client views the confrontation as legitimate, the client's perception of the confronter's motivation, and the level of emotional intensity involved in the confrontive exchange. Confrontation from multiple sources requires more focus, including confrontation from treatment peers, family members, the workplace, the legal system, social welfare workers, and medical professionals.