The ability to recognize harmful behaviors and the negative consequences of drug use is an important aspect of a person’s recovery. However, remaining in a state of denial prevents many people from understanding the toll that their harmful behavior takes on themselves and those they love.
Any level of denial can also make it difficult for a person to seek or become willing to receive help for their substance use disorder. This guide will examine the concept of denial, explore some common signs and symptoms of denial to look out for, and learn how to help someone who is in denial about their addiction.
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Denial & Addiction
The American Psychological Association (APA) defines denial as an involuntary “defense mechanism” that aims to ignore negative or unpleasant thoughts or feelings.1 In terms of substance use disorders, denial and “lack of awareness” are commonly seen among people during their early stages of recovery from substance use disorders, and they often contribute to a person’s resistance or lack of motivation in addiction treatment.2,3
Some feelings of uncertainty and ambivalence can be a normal part of the process of change — especially during early recovery. However, uncertainty and ambivalence can also serve as obstacles and may hinder a person from changing their substance use behaviors.3 Furthermore, denial may function as a way for someone to ignore the reality of their situation or diminish the severity of their substance use, especially when it pertains to the damage caused by their resistance to stop using.4
Though denial may be considered an involuntary process that functions to help a person resolve emotional conflicts or ease anxiety,1 it can be dangerous when it pertains to addiction and problematic substance use. Someone who is in denial about the harm their addiction is causing might be considerably resistant to change their behavior and engage in treatment. Furthermore, just as with certain other diseases, such as heart disease, type 2 diabetes, obesity, and others, when left untreated, substance use disorders can become lasting, progressing issues and can lead to overdose, long-term medical or mental health issues, and may even lead to death.5
For these reasons and more, it is essential for someone in recovery to be open and honest with themselves and others about their substance use. This can help them to understand the impact that their addiction has had on their lives, relationships, and families, and it can also empower them to actively engage in changing their unhealthy behaviors.3
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In the Prochaska and DiClemente “stages-of-change” model, these symptoms of denial are common during the precontemplation period, which is considered the starting point of a person’s recovery.6 During this stage, a person may be in denial about the severity of their addiction, and they may not intend to change their substance use.6,7 As a person’s denial evolves, they may go through the other four stages of recovery from addiction, or the “stages of change.” These include:6,7
- During this stage, a person starts to see their substance use as problematic. Though they may not make any changes to stop using, they recognize that there may be some need to change.
- This stage involves a person developing a plan of action to change their unhealthy behaviors. They may have already begun to make small changes to their substance use, and they are ready to create more lasting change.
- When a person’s denial evolves to reach this stage, they are in the midst of learning new skills and engaging in healthier behavior patterns to prevent relapse. In addition, the action stage represents the move from intention to actually doing the work to make the desired changes.
- This stage is about the long term. At this point, the person is practicing and strengthening skills and coping strategies that will help them maintain their new behavior pattern and prevent relapse.
Though the goal for someone in denial is to be able to maintain healthier patterns and ultimately stop their substance use, it is important to understand that addiction is considered a relapsing disorder.5 This means that a person may find themselves cycling back and forth through earlier stages after each unsuccessful attempt to change their substance use.6
Reasons People Who Abuse Substances Deny Addiction
There are many reasons a person may be in denial about their substance use disorder. Some of these include:
- They believe that they are in control of their substance use.
- They are ashamed to admit that they have a problem.
- They are using alcohol or drugs to cope with other issues.
- They may have loved ones who are enabling their substance abuse.
- They are convinced that they are somehow “different” than other people who are addicted to drugs or alcohol.
Even if someone contemplates the idea that their substance use could be problematic, they may still find it hard to confront the severity of their addiction within themselves. One possible reason for this is that long-term drug use can impair a person’s cognitive functioning, which can impact their ability to stop using substances and to accept that they may have a substance use disorder.6 Another reason could be that they are afraid to accept their substance use as being problematic given that they would then have to change the behavior.6 This can especially be challenging for someone who views substance use as a way to cope with underlying issues.
How To Help Someone Who Is in Denial About Their Addiction
There are many treatment options available to help people who are struggling with substance use disorders, some of these include:8,9,10
- Inpatient and residential treatment.
- Outpatient rehab programs.
- Individual drug and alcohol counseling.
- Group therapy.
- Virtual recovery programs.
- Mutual support groups and self-help programs.
It may be difficult for someone who is in denial about their addiction to be willing to seek out some of the treatment options listed above. In this case, even for a person who does not feel that they have a substance use disorder, it may be beneficial if they attend a mutual help group recovery meeting, like Narcotics Anonymous (NA), Alcoholics Anonymous (AA), or SMART Recovery, in order to show them they are not alone and there are others who are experiencing similar issues. Additionally, speaking with a therapist, talking to people who are in recovery, confiding in their physician, and exploring recovery resources may empower a person in denial to seek help on their terms.
If you have a loved one who is struggling with addiction, you may feel overwhelmed and uncertain about how to help them, especially if they are in denial about their unhealthy substance use. Fortunately, there are resources available to help you find support for your loved one such as the Substance Abuse and Mental Health Treatment Administration (SAMHSA) and the National Institute on Drug Abuse (NIDA). You can also start researching rehab facilities, such as American Addiction Centers (AAC) to find out about what to expect during treatment, how to pay for services, and more.
Remember to keep your own mental health intact. There are ways that you can support both your own needs that can still help your loved one on their journey to recovery. These include:6,11
- Setting healthy boundaries and allowing your loved one to experience some of the natural consequences of their addiction.
- Attending support groups for families and friends of loved ones with substance use disorders and addiction, such as Al-Anon, Nar-Anon, SMART Recovery Family & Friends, and more.
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- American Psychological Association. (n.d.). Denial.
- National Institute on Drug Abuse. (2000). Approaches to drug abuse counseling.
- Substance Abuse and Mental Health Services Administration. (2019). Enhancing motivation for change in substance use disorder treatment. Treatment Improvement Protocol (TIP) Series No. 35. SAMHSA Publication No. PEP19-02-01-003. Rockville, MD: SAMHSA.
- Rinn, W., Desai, N., Rosenblatt, H., & Gasfriend, D. R. (2002). Addiction denial and cognitive dysfunction: A preliminary investigation. Journal of Neuropsychiatry and Clinical Neurosciences, 14(1), 52-57.
- National Institute on Drug Abuse. (2020, July 13). Drug misuse and addiction.
- DiClemente, C. C. (2003). Addictions and change: How addictions develop and addicted people recover. New York, NY: Guilford Press.
- Substance Abuse and Mental Health Services Administration. (2012). TIP 34: Brief Interventions and Brief Therapies for Substance Abuse.
- National Institute on Drug Abuse. (2020, June 3). Types of treatment programs.
- Substance Abuse and Mental Health Services Administration. (2021, July). Staying connected is important: Virtual recovery resources.
- Rural Health Information Hub. (2020, November 23). Mutual support groups and self-help programs.
- Substance Abuse and Mental Health Services Administration. (n.d.). Alcohol and drug addiction happens in the best of families.