Understanding Addiction Denial and the Road to Recovery

Denial by people suffering from a substance use disorder (SUD) is a common defense mechanism in the process of relapse prevention or recovery. This is so despite the negative consequences of a person’s continued substance abuse. By learning the forms this takes, loved ones and friends can better understand and help someone find their path to recovery.

Denial in Addiction

The stages of the change model are helpful in explaining the process someone may go through as they grapple with their addiction. The stages are pre contemplation, contemplation, preparation, action, maintenance, and relapse prevention.

Denial is most commonly experienced in the pre-contemplation stage when someone with a SUD likely doesn’t view themselves as having an addiction. Nor are they ready or willing to assess their actions. As they begin to do so and consider that they may have a problem, they move into the contemplation stage. However, they may stay in the pre-contemplation stage for a very long time, embracing denial.

There are a number of different forms denial can take, depending on the individual:

• Minimizing: Downplaying the extent of substance use or making excuses such as: “I only used twice today.” The person believes they have control over their substance use. Minimizing allows them to believe they still have control and avoid taking responsibility for their addiction.
• Rationalizing: People with SUD may develop explanations or justifications for their continued substance use, trying to make it acceptable.  Statements such as “My week was rough, so I just had a couple of drinks to get over that.” This creates a false sense of justification, allowing them to continue using it.
• Blame: Pointing to another person or external factor may be an easier choice than taking responsibility, at least in the short term. “My boss or co-workers are awful, and they drive me to drink” or “I had a stressful day” may be a typical form of denial. This allows users to deflect responsibility and not have to face the underlying issues giving rise to their addiction.
• Concealing: Hiding or masking proof of substance abuse is sometimes used, e.g., concealing substances or using breath mints.
• Self-deception: Telling yourself, “I don’t have a problem,” or “It’s not that bad, so don’t bug me, okay,” are classic examples of refusing to acknowledge a problem.
• Avoiding responsibility: Lying, manipulating, or denying the impact of their behavior on someone else or themselves are ways of maintaining the addictive behavior without dealing with the need for change.
• Becoming Defensive: Avoiding talking about specific issues and the impacts of their addiction on themselves and others may reflect shame, embarrassment, or fear of being misunderstood or judged.

A person with an SUD may adopt a mix of these forms, making it challenging for a loved one or friend to provide help.

Signs of Denial in Addicts

As a defense mechanism, the psychodynamic view is that denial is a way that people with SUDs unconsciously avoid facing truths that can cause them emotional pain. Although denial can offer temporary relief, it brings with it longer-term consequences on mental health, personal relationships, and a general sense of well-being.

There are many ways denial can be expressed, whether it be a direct denial of someone’s addiction and substance abuse, a denial of their physical illness, or a denial of their responsibilities to themselves and others. One of the common characteristics of denial is resistance to any information that goes against their attitudes and beliefs, e.g., evidence of drunk driving, poor work performance, or repeated detoxes with relapse.

Another view of denial is from the perspective of cognitive failure. This view, proposed by Rinn et al. [1], suggests that it is not always due to an ego defense mechanism with emotional resistance, or a simple failure of insight. There may be mental rigidity, concreteness of thought, and poor ability to deal with complexity.

Rinn et al. suggest this can be characterized by:

• Diminished capacity for insight
• An inability to integrate readily available information to draw an obvious conclusion
• An inability to develop an organized, systematic approach to for searching memory
• An inability to search the environment for evidence of alcoholism
• Poor ability to discriminate relevant from non-relevant evidence.

Signs of denial in addicts and their consequences include:

• Sustained substance abuse: With their failure to recognize the need for change, a person may prolong their addictive behavior, resulting in further physical, psychological, and social consequences.
• Deteriorating health: When an addict is in denial, they may fail to see the negative impact of their addiction on their physical and mental health. This often leads to a deterioration in these aspects of their health with a greater risk of medical complications.
• Deteriorating relationships: Loved ones, family, and friend relationships are put under stress through an addict’s denial. This may result in damaged trust, frequent conflicts, and the negative effect of a lack of understanding or support from loved ones, the very people who can help.
• Financial, professional, and legal difficulties: If denial inhibits people from seeking help in the earlier stages of their addiction, a variety of material issues may develop, each increasingly difficult to resolve.

How Does Denial Affect Recovery?

Awareness by someone with an SUD that they have a problem is key to recovery. One study explained why those who are diagnosed with SUD don’t perceive they have a substance use problem [2]. They found that low problem recognition is a primary barrier to seeking treatment. They noted that being high-functioning, i.e., holding down a job and having a fear of stigma and labeling associated with an SUD, were significant barriers to treatment.

Confirmation bias plays an important role as well. People attach value to information that confirms their pre-existing beliefs about themselves and addiction. Sometimes, these beliefs are held unconsciously [3]. Addicts are experts at doing this, as they continue to believe they don’t have a problem.

These factors make it difficult for someone with an SUD to acknowledge their need for change and for help.

How to Help Someone in Denial?

The core of emotional relapse in addiction is poor self-care, i.e., emotional, psychological, and physical care or some combination of those. Within this view, the primary goal of helping someone overcome their resistance and denial of their addiction is to help them see the benefit of improving their self-care. However, those with SUDs are typically not future-oriented, as their focus is satisfying their addiction in the short term.

Here is guidance for having conversations with someone with an SUD to help them overcome their denial of having an addiction and need to make a change in their self-care.

• Educate yourself: Learn about addiction and mental illness to better understand what they are going through and the best ways to help.

• Understand the stage they are at. When talking with a person with SUD who is in denial, it’s key to identify what stage they are in and then how best to approach the problem constructively.

• Create a supportive, non-judgmental environment to help them feel safe and comfortable to open up. Understanding which defense mechanisms are at play loved ones and therapists can offer a compassionate, empathetic approach.

• Remain calm and composed: This increases the possibility the person will not view you as threatening and that you will manage your own emotions better..This can help reduce defensiveness and create a constructive dialogue.

• Focus on the benefits: For example, the goal of therapy at the contemplation stage is to assist them in seeing the benefit of identifying their denial. One way this can be done is to ask the person to compare their current behavior to past behavior during relapses and see if their self-care is improving or worsening. Sharing resources such as professional help, detox and treatment centers, or support groups can help the person feel supported and have options.

• Be sensitive and non-confrontational: Don’t plead, urge or threaten the person. Resist confronting them. This will just harden their defensive responses and denial. Use “I” statements to express your concerns and experiences and help them to not feel fear, blame, accusation or stigma. Share specific examples of the person’s behavior to help them gain insight into its impact.

• Encourage the person to get help and support: Offer resources such as therapy choices or support groups to take steps for their recovery.
  

  

• Be aware of manipulative tactics: People in denial may use a variety of ploys to minimize their addiction or deflect the conversation entirely. Setting clear boundaries is essential. Refuse to be an enabler of their destructive behaviors. Only by doing so can you help the person see and take responsibility for the consequences of their patterns and actions.

Overcoming Denial in Addiction

Since denial and resistance to change in addiction can be so powerful, it’s important to be consistent in communicating with a person with SUD. This may require many attempts to share with them the impact their addiction has on them, their family, loved ones, friends, and co-workers.

This may consist generally of three types of communication:

• Direct confrontations (in a supportive manner) with the person to share the impact of their behavior and refusal to see the need for change. Family and friends may participate in these sessions to provide multiple perspectives on the impact of their addiction.

• Support from a professional counselor or therapist skilled in effective communication techniques to help the person gain insight and overcome their fear, shame, and guilt as the denial exists to prevent acknowledging these emotions.

• Support from a professional interventionist: They are expert at employing ways to facilitate the process of overcoming the person’s denial. And they are familiar with all the ploys an addict may use to avoid facing the truth.

With love and support together with clear, firm boundaries, it’s possible to help someone overcome their denial and begin their healing journey to greater self-care.

Sources

[1] Rinn W. et al. 2002. Addiction Denial and Cognitive Dysfunction: A Preliminary Investigation. The Journal of Neuropsychiatry and Clinical Neurosciences. Volume 14, Number 1.

[2] Rogers S. et al. 2018.. “I Don’t Feel Like I Have a Problem Because I Can Still Go To Work and Function”: Problem Recognition Among Persons With Substance Use Disorders. Subst Use Misuse. 2019;54(13):2108-2116.

[3] Heshmat S. 2018. The Role of Denial in Addiction. Denial is a key obstacle to recovery.

Currin-Sheehan K. 2021. Substance Use Disorder: The Power of Acceptance. PsychCentral.

Dexter, G. 2024. Signs of Addiction Denial. verywellhealth.com