Denial and Drug and Alcohol Abuse

In times of great stress, we shut down our awareness emotionally, sometimes intellectually and occasionally physically.

Denial is a built-in mechanism operated to screen out devastating information and to prevent us from becoming overloaded. Denial is a conscious or unconscious defense that all of us use to avoid, reduce, or prevent anxiety when we are threatened. We use it to shut out our awareness of things that would be too disturbing to know. Denial isn’t lying. It’s not letting yourself know what reality is. We usually deny what we have lost, are losing, or suspect we’re losing.

Denial eliminates the possibility of change. Take a moment and think about denial. It doesn’t just relate to addiction. Where and when in your life have you exhibited denial? Examples may include work, school, loss of a family member or friend or an illness. Now that you’re thinking about it, have you seen your parents, other family members or friends exhibit symptoms of denial?

5 Stage Process of Denial

Elisabeth Kubler-Ross first observed and documented a five-stage process, the grief process, in her work with terminally ill patients, however, this information fits perfectly within the denial and substance abuse recovery framework.

1. Denial – this is generally everyone’s first reaction to loss. People will deny until they feel safe enough to cope with the loss another way.
2. Anger – this stage is characterized by blame, envy, resentment, and sometimes rage. We may blame others or ourselves for the spot we now find ourselves in. We may find ourselves envying those who have what we have lost. Switch in this stage from “not me” to “why me?”
3. Bargaining – after venting our anger, we may try to make a bargain that will prevent or postpone the loss. This stage is usually characterized by “if…, then…” statements which measure what we give against what we get (If I give up drinking, then I’ll do better at work). Often the bargains are not realistic (I’ll give up hard liquor but not beer).
4. Depression – We now move into a period of sadness and begin to mourn. This is the peak of the acceptance process and it is emotional pain at its purest. We grieve over what we have lost and over what we will lose in the future. It’s time to cry.
5. Acceptance – Acceptance should not be mistaken for a happy stage or for hopeless giving up. It is almost devoid of feelings. It is as if the pain is gone and the struggle is over. We are at peace with what is. Following acceptance there is growth, but the journey is not easy or particularly comfortable. It can be awkward and one may feel panic, confused, vulnerable, lonely and/or isolated.It is often difficult to recognize denial in yourself – it’s like realizing that you are asleep; you only realize when it’s over that you’ve been doing it, but we don’t think much about it while we’re doing it. However, some cues may indicate that someone is in denial.

A different take on Kubler-Ross is the following:

1. Refusing to believe reality: this is characterized by statements like, “I don’t believe it,” or “It can’t be true,” “This couldn’t happen to me.” Person then proceeds to conduct themselves as though the event, problem, or loss doesn’t exist.
2. Denying or minimizing the importance of the loss: Person says that whatever happened was “no big deal.” Admit to the reality of a thing, but insist it is not as serious as others think. May accuse others of overreacting to the situation.
3. Denying any feelings about the loss: This is emotional repression. Person may act and look like s/he doesn’t care, appearing emotionally flat.
4. Mental avoidance: We avoid things mentally in several ways: might sleep excessively, be hyperactive running from one thing to another, may become driven by compulsions or obsessions, may lose ourselves in front of the TV, computer or under the headphones of a walkman. People avoiding reality will also go to great lengths to escape situations that confront their denial system (like not wanting to come to treatment or go to AA meetings). Instead, they will seek out situations and people that support their denial (old friends and places).

Tools to deal effectively with someone in denial:

1. Examine your motives: do you really want to help the person or are you trying to control or interfere? Are you angry, resentful or afraid?
2. Give healthy permissions: allow others to think, feel and solve problems. Allow others to be who they are and be where they’re at in their growth process.
3. Listen!
4. Talk about yourself and your own emotions and experiences without “lecturing”. Don’t be pushy and don’t preach – give the person of yourself.
5. Display empathy: put yourself in the other person’s shoes.
6. Avoid judgments: people have problems, the person is not the problem
7. Don’t argue: it doesn’t help and it diverts attention and wastes time and energy. You should not support or agree with denial, but neither should you attempt to pound reality into a person
8. Respect people: you don’t have to respect unhealthy behaviors, but respect the person
9. Respect yourself: set boundaries
10. Confront carefully, thoughtfully and with loving intention
11. Detach: don’t take it personally; don’t assume responsibility for their problem
12. Trust yourself: remember progress not perfection

Recovery from substance abuse isn’t just about stopping the use of drugs and alcohol. This is a multi-faceted problem and needs to be addressed from a biopsychosocial perspective. Attending individual addiction therapy or enrolling in a drug and alcohol treatment center can be key to ensuring a recovery that addresses the whole person and not just one area.