Is It Resistance, Non-Compliance, or a Need for Better Service?

When Marcus entered treatment, he was hopeful (and terrified). He had cycled through years of opioid use, arrests, and strained family relationships. Sitting in the intake room, he answered the counselor’s questions as best as he could, but struggled with eye contact and quick, defensive answers. Within his first two weeks in the program, Marcus missed a therapy group due to a transportation issue and challenged a staff member when he felt disrespected. Soon after, the team labeled him “non-compliant” and Marcus was discharged.

But Marcus wasn’t being “resistant”… He was exhibiting the very symptoms of trauma, distrust, and instability that the treatment was supposed to help heal. His discharge wasn’t a failure of his commitment, it was a missed opportunity for deeper engagement.

Understanding the Nature of Substance Use Disorder (SUD)

In the world of Substance Use Disorder (SUD) treatment, patients are fighting an illness that affects their brain, behavior, trust, and resilience. Exhibiting symptoms during treatment ; like anger, withdrawal, missed appointments, or mistrust isn’t surprising. It’s expected.

Early in her career, our CEO, Jamelia Hand, worked as an addiction counselor. Over time, she noticed something alarming: many patients who struggled within treatment programs weren’t being given tools or compassion to succeed. Instead, they were being labeled as “treatment resistant” or “non-compliant”, labels that justified discharging them early, sometimes at critical moments in their recovery.

This sparked a question we still believe every provider should ask:

Are patients truly resistant, or is the care sometimes mismatched, rigid, or poor?

The Myth of “Treatment Resistance”

Labeling a patient as “resistant” can sometimes reflect our own limitations as providers, not the patient’s inability to heal. True treatment resistance is rare; what’s more common is:

• Mismatch between services offered and patient needs

• Communication breakdowns between staff and patients

• Lack of trauma-informed practices

• Cultural or socioeconomic misunderstandings

• Systemic barriers like lack of transportation, housing, or childcare support

Patients often want to get better, they just may not know how, may not trust the system, or may be overwhelmed by untreated trauma and life instability.

When a patient struggles to engage, it’s not a cue to discharge, it’s a cue to dig deeper.

Why Patient Complaints are Gifts

In today’s healthcare environment, patients have options. They can and should advocate for themselves. If a patient voices dissatisfaction, it’s easy to become defensive; however, it’s far more powerful to view complaints as an early warning system for program improvement.

Every complaint is a chance to ask:

• Are we truly listening to our patients?

• Are our services aligned with the needs they came here to heal?

• What small changes could turn frustration into recovery momentum?

Research from the Substance Abuse and Mental Health Services Administration (SAMHSA) has shown that patient-centered care ( tailoring care based on individual strengths, barriers, and preferences) dramatically improves retention and outcomes.

Redefining Success: Meeting Patients Where They Are

High-quality SUD programs recognize that treatment is not a privilege patients must earn, it is a right they deserve.

Real success comes from programs that:

• Expect patients to struggle as part of recovery

• Offer flexible engagement strategies (motivational interviewing, contingency management, harm reduction approaches)

• Treat non-compliance not as rebellion but as communication of unmet needs

• View cultural humility and trauma-informed care as daily practices, not checkboxes

When we redefine “success” in treatment, it stops being about compliance with program rules and starts being about healing the whole person.

How Vantage Clinical Consulting Can Help

At Vantage Clinical Consulting, we help treatment programs move beyond outdated models of care that label and discharge patients too quickly. We offer:

• Service Quality Assessments to identify gaps in patient-centeredness

• Staff training on trauma-informed care, patient engagement, and communication strategies

• Complaint analysis to transform feedback into actionable improvement

• Program redesign to help you serve patients more effectively and boost retention

Because when patients thrive, programs thrive.

Final Thoughts…

Marcus eventually found a program that treated his anger not as a problem, but as pain asking to be heard. With the right support, he graduated from treatment, repaired his relationship with his mother, and now works as a Peer Recovery Coach.

He wasn’t resistant. He was reaching for help and eventually, someone listened.

What can we do to make sure we are the ones who listen, the first time?

Contact Vantage Clinical Consulting today to strengthen your program, your staff, and the lives you are called to serve.

#SubstanceUseDisorder #PatientCenteredCare #AddictionRecovery #QualityImprovement #SUDTreatment #HealthcareExcellence #TraumaInformedCare