A Psychosocial Perspective on Treatment Resistance



by Eric M. Plakun, MD

Eric M. Plakun, MD, DLFAPA, FACPsych, Associate Medical Director and Director of Biopsychosocial Advocacy at the Austen Riggs Center.This text originally appeared in Paradigm Magazine Vol. 20(3) 2016. Reprinted by permission of Paradigm magazine, Las Vegas, NV (214-295-6332)—www.addictionrecov.org

If our drift toward biological tunnel vision has narrowed our psychosocial perspective so much that treatment resistance emerges more frequently, then it is wise to broaden our psychosocial approach to patients.

Despite advances in research methodology and efforts in the mental health and addictions fields to move toward evidence based treatment, large numbers of patients fail to respond to our best evidence based treatments. This has led to growing recognition of the phenomenon of treatment resistance. For example, during recent 20-year period overall Medline citations in psychiatry increased 25%, while citations on treatment resistance increased 800% (Mintz & Belnap, 2011). 

Although there is no universal definition of treatment resistance, as used here and in much of the field it refers to failure to respond adequately to at least two evidence based treatments to which a patient has adhered. The problem of treatment resistance is related to the complexity of mental health and substance use disorders, but also to the drift toward a biologically reductionistic stance that takes a narrow, unimodal view of mental disorders. For example, most algorithms for treatment of depression offer a rational sequence of steps for choosing medications, with little or no attention to psychosocial factors and how they may be part of the causation and treatment of this mood disorder. It is my contention that the drift toward biological tunnel vision is based in large part on widespread and sometimes unwitting belief in three false assumptions about mental disorders that emerging science suggests are untrue (Plakun, 2015).

Three False Assumptions

These include that (a) genes = disease; (b) patients present with single disorders that respond to evidence based treatments; and (c) the best treatments are pills. 

To read more about the “Three False Assumptions” and this article in its entirety, click here.