Introduction:
Substance use disorder in adolescence is a pressing public health concern linked to developmental trauma, affective dysregulation, and social marginalization. Emerging research identifies deficits in mentalization—the capacity to understand oneself and others in terms of intentional mental states—as a key psychological vulnerability in youth addiction.
Purpose:
This study aimed to explore the mentalization characteristics of drug-addicted adolescents and how these features evolve throughout different stages of recovery within therapeutic communities.
Method:
A mixed-methods longitudinal design was used, involving 20 participants aged 14-20 residing in a residential drug treatment program. Quantitative assessments included the Reflective Functioning Questionnaire (RFQ-54), Adverse Childhood Experiences Questionnaire (ACE-IQ), and the Self-Affliction Tendency Scale (SATS). In-depth semi-structured interviews were conducted at three time points (entry, 6 months, and 12 months) to track changes in mentalization, attachment, and narrative reconstruction.
Results:
Findings revealed that participants exhibited high uncertainty and low reflective functioning at intake, often associated with fragmented self-concept, emotional dysregulation, and interpersonal distrust. Over time, especially among those with stable engagement in therapeutic relationships, significant improvements were observed in emotional awareness, impulse control, and perspective-taking. Notably, recovery was mediated by enhanced affect regulation and the capacity to mentalize distressing experiences, supporting the inclusion of mentalization-based treatment strategies in adolescent rehabilitation settings.
Conclusions:
This study highlights mentalization as both a vulnerability and a developmental target in adolescent addiction recovery. It provides empirical support for integrating trauma-informed, mentalization-based interventions within youth treatment systems to promote sustainable psychological recovery and relational resilience.