Understanding the context of confrontation: Implications for recovery from substance abuse

Confrontation about alcohol and drug use is a common experience for substance users, often involving family, friends, professionals and peers. Yet confrontation is controversial in the treatment field and can be perceived as negative and harmful rather than beneficial and motivating. To better understand confrontation, it is necessary to distinguish the conditions that influence how confrontation is experienced.

We analyzed qualitative data from in-depth interviews conducted with 40 AOD users in Northern California in 2008. The sample was recruited from a larger, longitudinal study of AOD users who were former residents of recovery homes. The interviews inquired into participants' positive and negative experiences of confrontation, defined as warnings about possible negative consequences of their substance use.

Analyses suggest that AOD users' experience of confrontation is shaped by their “readiness” for it (reflecting their use history and life circumstances), beliefs about recovery and for some men, masculinity, and stage of sobriety. It is also influenced by perceptions about confronters' experience or knowledge of addiction, the confronter's relationship with the user and their confrontational approach. The most helpful confrontations have perceived validity; are from persons the user admires and respects; are delivered with concern and caring; offer hope, critical opportunities or practical help; and occur at a time when the user is “tired” of using. We conclude that confrontation can be an important experience and tool in recovery. Results will highlight for policy makers and treatment providers when confrontation is experienced as supportive and helpful and when confrontation may be counterproductive.