Denial is the primary mechanism by which drug addiction, alcoholism and relapse are maintained, prolonged and worsened. In fact, some have questioned whether outright addiction could exist at all if not for a state of denial. And while it might be obvious that tolerance and physical dependence can occur without the maintenance and facilitation of denial, it’s likely that in most cases substance abuse and alcoholism could be quickly and effectively treated – perhaps permanently – if not for the existence of denial among addicts. However, denial appears to be an inseparable part of addiction and therefore must be understood in order to treat it effectively for the lifetime of the sufferer.
Simply put, denial is a series of lies, omissions of truth, falsifications, exaggerations, justifications and behaviors like turning a blind eye, pretending a problem doesn’t exist or isn’t as bad as it seems, avoiding people who would disapprove of substance abuse or alcoholism, and much more. The central theme is that these characterizations of denial all serve one purpose: to permit the addicted individual to continue using unabated and without consequence.
However, the process of denial extends to the people around the addict or alcoholic, including the general public. According to Neuroanthropology.NET, this occurs primarily as a result of misconceptions about addiction:
“This misconception is that chemical dependence is not a disease. By not recognizing chemical dependence as a disease, society continues to hold harmful stereotypes about alcoholism and drug addiction.” (1)
This is especially important to note because while people with serious and debilitating diseases like cancer or diabetes almost invariably seek medical treatment for their conditions, sufferers of the disease of addiction or alcoholism rarely seek help on their own volition and often refuse medical help even when insisted upon by people close to them. This is because addiction is facilitated by denial.
An addict’s state of denial can be complex, simple, or a varying combination of the two. People who are dependent on drugs often say things like: “It’s not that bad.” “I can handle it.” “No one will know.” “Just one more time.” “I need this.” But in general, a state of denial can extend deep into the addict’s life and affect the people who are closest to them. Dr. William Rinn of Harvard Medical School’s Spaulding Rehabilitation Hospital describes the characteristics of denial in relation to alcoholism:
“Denial is a common feature of addictive disease. Patients with alcohol dependence often underestimate the amount of alcohol they consume, the duration of their drinking problem, or the impact alcohol has had on their personal life or health. They are likely to overestimate their ability to control their drinking or to quit without assistance. In some cases, their perceptions go against compelling evidence of the severity of their problem. For some, the denial is fragile and is easily penetrated when they are supportively confronted with the facts. (e.g., liver disease, drunk driving arrests, repeated detoxifications). For others, the denial is fixed and is unaffected by confrontation with the evidence.” (2)
Denial is the reason that many addicts require an intervention in order for treatment to occur. An intervention can be something as devastating as a car accident or drug overdose, or it can be a group of friends and family gathering together to “intervene” by letting the addict know how serious the problem is, how it is affecting others and suggesting that the person take immediate steps to get help. However, just because an intervention is successful doesn’t always mean that any significant denial issues are addressed:
“When a family intervention is conducted to help a person engaged in self-destructive behavior such as alcohol or drug abuse to accept help for his problem, denial is sometimes reduced or eliminated altogether. This is not always necessary, however, for the intervention to be successful in having the person accept help.” (3)
Treatment options for drug addicts and alcoholics include programs like residential inpatient treatment, outpatient treatment or a day/night treatment program. Drug rehab centers that offer such programs employ a multitude of evidenced based practices and reality based treatment to address issues of denial. This includes cognitive behavioral therapies, one-on-one counseling sessions, group therapy, family therapy and biofeedback. The most successful programs place a primary focus not only on denial management, but also on management of Post Acute Withdrawal Syndrome symptoms. But according to Debbie Davis of Recovery First’s Florida drug rehab center, denial must be addressed with a two-pronged approach:
“Drug treatment seeks to uncover issues hidden through denial and deception, but addicts are often in denial about their own abilities to get clean and stay clean. Therefore, denial management must work to uncover the suppressed talents, aspirations, skills and dreams as much as it uncovers lies and fraud.” (4)
Unfortunately, denial isn’t something that can be permanently treated at a 30 day treatment program. Recovery from addiction is a lifetime process, and denial management is a large part of this. In fact, just as denial makes addiction and alcoholism possible, it can also lead to relapse after treatment. Recovering addicts that begin to think thoughts such as: “I can have just one drink” “My drug problem was never really that bad” and other dangerous thought patterns can lead to a relapse.
However, the issue is even more complicated than this. Recovering addicts may deny the level of stress they are under, the level of drug or alcohol cravings they are experiencing, or any number of feelings that may set the stage for a relapse. For this reason, denial management is a daily process where people in recovery must take an honest self assessment and make changes to their behaviors or attitudes in response to their findings.
All relationships require effort to sustain, and this applies to the relationship between addicts and their recovery. If your recovery has been set back because denial has caused you to relapse, reach out for help right now. It’s important to understand that sometimes relapse is simply part of the process of learning how to beat addiction. If you’re using again, call the number at the top of the screen right now for a free, confidential consultation. We can help you no matter where you are or how bad the problem seems to be, but we can’t do anything if you deny this call.
(1) Neuroanthropolgy.NET It’s Our Fault: Denial, Disease and Addiction
(2) William Rinn, Ph.D., Nitigna Desai, M.D., Harold Rosenblatt, M.D. and David R. Gastfriend, M.D. Addiction Denial and Cognitive Dysfunction: A Preliminary Investigation J Neuropsychiatry Clin Neurosci 14:52-57, February 2002
(3) Wikipedia Denial
(4) Davis, Debbie Understanding Drug Addiction and Denial Management