Addiction & Denial

Denial, the topic for this week’s discussion, is unfortunately not a river in Jordan. While not a river, it is a characteristic that at times seems to be as resistant to change as the most torrent watercourse. Denial has been described as many things in many ways by many people and still I find the Webster’s Dictionary definition of denial to be the most meaningful and accurate:
“an assertion that an allegation is false…disbelief in the existence or reality of a thing…self-denial…[and] the reduction of anxiety by the unconscious exclusion from the mind of intolerable thoughts, feelings, or facts” (1977).

The readings and following class discussion illuminated just how varied and vast denial can manifest itself, especially with alcoholics and addicts. The discussion concluded that denial may be noticeable in the form of 1) an individual not being able to accept what is in front of him; 2) a coping mechanism to deal with facts as presented; or 3) the inability to see consequences of one’s behavior. Also based on the class discussion, things a counselor can look for to discern if a person is in denial are 1) if they consistently miss or avoid scheduled sessions, or while in sessions they continually change the subject; 2) if clients appear to reject logic or reason; 3) clients demonstrate incongruence, that is their non-verbal expression and actions are inconsistent with what they say; and 4) clients demonstrate the various defense mechanisms associated with alcoholism, addiction, and denial.
These defense mechanisms can be in the form of projection, (“I don’t have a problem –you have a problem.”) rationalization, (“It helps me relax/concentrate/forget” or “I’ll stop as soon as the pressure lets up”) justification, (“Everyone I know does it”) suppression or repression, (forcing down memories of using behavior and negative consequences as a result of that use and behavior) and one that sometimes gets overlooked, geographic escapes (my life is unmanageable – but it’ll get better if I move to another place.)
The text also offered some useful information in understanding the phenomenon of denial. On page 30 of the text Assessment of Addictive Behavior, Tarter, Alterman, & Edwards (1985); Tarter & Edwards (1986); Tarter, Hegedus, Goldstein Shelly, & Alterman (1984) suggest that “…neuropsychological deficits among alcoholics, particularly deficits in accurately perceiving internal cues of physiological arousal and emotion and in appraising the significance of environmental events, may underlie what has been described as ‘alcoholic denial’ ” (cited in Donovan & Marlatt 1998). In other words people may be so impaired from the damage heavy drinking causes on the brain they may not have the capacity to comprehend beyond their “denial reality.” In addition, on page 223 of Psychotherapy in Chemical Dependence Treatment, Rugel and Barry (1990) state, “denial is a way to defend against loss of self-esteem occasioned by negative public and self-valuation.” They go on to say, “Denial, therefore, may be a necessary step in the recovery process, required in order to defend the ego.” Interestingly, Rugel and Barry found that in groups where clients felt safe and supported enough early on in the treatment process to do self-exploration, a reduction in the need for the clients to erect denial defenses resulted. However, in groups where there was a big emphasis on the venting of powerful emotions of remorse and shame, via cathartic exercises, denial and defense mechanisms were reinforced (cited in Buelow & Buelow 1998). This is important information for those of us who may be providing substance abuse counseling to know, because we may need to be more sensitive to the techniques we introduce so as not to impede the counseling process for clients but rather enhance it.
As far as my thoughts are concerned, I agree with the class, in that, I believe denial is both a conscious and an unconscious characteristic of alcoholics and addicts. People may be consciously aware they have a problem but due to shame or guilt are unable or unwilling to admit it. While on the other hand fear may unconsciously push addicts into denial. Based on my four years of personal recovery and two years of providing substance abuse counseling, I have found that people who are afraid to face their problems often start practicing denial even before they are addicted but then as the addiction progresses, it causes its own problems. At which point the idea of facing reality can be so frightening and overwhelming people are unaware that underneath it all they have become addicts. This personal observation is congruent with Professor Charles-Heathers’ assertion that denial is most probable a cyclical dynamic whereby people may move through stages from low level denial, which may not have much in the way of consequences, to high level denial, which may affect a persons ability to function from day to day and lead to loss of relationships, children, jobs, freedom or worse…
Lastly, there are many strategies for addressing denial. Some of the suggested strategies by the class were life stories, family groups, self-assessments exercises, significant other interventions, building and establishing rapport and trust with the client, journaling, education, and self-disclosure. My final thoughts are this; denial is a defense mechanism that enables people to survive situations and abuses that they would not be able to otherwise tolerate. It also allows clients to be where they need to be until they are ready to face what it is that was previously pushed away or avoided. Facing a problem is the first step to solving it. I personally know that addiction is difficult to overcome alone. So, as counselors we are there to help clients face their problems not with judgment but with nurturing, respect, education, support, and encouragement. I have seen first hand the phenomenon of people moving from the paralysis of denial to the miracle of recovery by the simple act of someone believing in them.

References

Buelow, G. D., & Buelow, S. A. (1998). Psychotherapy in chemical dependence treatment: A practical and integrative approach. Pacific Grove, CA: Brooks/Cole.

Donovan, D. M., & Marlatt, G. A. (1998). Assessment of Addictive Behaviors. New Your, NY: Guilford Publications.

Steinmetz, S. (Ed.). (1997). Webster’s college dictionary (2nd ed.).
New York: Random House.


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