The Role of Denial in the Power of Addictive Disease

By: Jan Edward Williams

Persons with addictive disease continue to use their substances in the face of a long history of adverse consequences in significant areas of their lives, including medical problems, legal problems, relational problems, and employment problems. The drive to use is stronger than one's love for a significant other or a child; stronger than loyalty to an employer or a friend; and stronger than one's values or even spiritual tenets. Persons with addictive disease continue to use long after any rational individual would choose to do so. This article provides a brief explanation of the role of denial in the power of addiction.

Some definitions

The term drug or alcohol addiction is used to mean a primary, chronic, disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, craving, and continued use in the face of adverse consequences. Addiction can develop with frequency of use of as little as two-to-three times a week. An example of addictive disease is alcoholism, or heroin addiction.

A person with addiction may, or may not, develop physical dependence and experience physical withdrawal symptoms upon stopping use; physical dependence usually requires use of alcohol or other drugs many times a day, every day, for a substantial period of time. A diagnosis of addiction does not require the presence of physical dependence.

Denial

Denial is a complex concept that includes many factors. We will focus here on factors commonly understood in the addictions treatment field to operate to cause the addicted person to be out of touch with the reality of the adverse effects of drug or alcohol use. We will use simple understandable, non-technical terms.

Denial in the alcohol or other drug (AOD) addicted person includes the following factors which operate, except for Item 1), in part unconsciously, or, at times, semi-consciously:

1) Deliberate lies.

Addicted persons, be they alcoholic or addicted to illegal drugs, lie and manipulate to protect their ability to satisfy the need to use their DOC (drug of choice). They also lie to themselves and come to believe their own distortions. Addicts who must buy their drugs from illegal sources and use illegal means to finance purchases, will be particularly adept at deliberate falsification and skillful manipulation.

2) Alcohol/drug-induced amnesia (blackouts).

Present inability to recall events occurring while under the influence adds to the "denial" problem. The AOD addicted person in truth cannot remember many of the negative events he/she may be accused of, which adds to the confusion, frustration and delusion of the user (and to the frustration of those close to him/her).

3) Euphoric recall.

Recall of events while AOD impaired tend to be distorted. The AOD addicted person also tends to recall only the good times, not the bad, a selective memory.

4) Denial in Significant others.

Those close to the AOD addicted person experience denial in forms similar to that of the addict or alcoholic, and tend to enable, that is, protect the user from experiencing the natural consequences of his/her inappropriate behaviors.

5) Lack of feedback or ability to reality test what's going on.

Because of the dysfunction which develops in intimate relationships, the AOD addicted person has no way of reality testing, that is, he/she is given no useful feedback about the reality of AOD use and its real impact on significant others. The usual rule in such families is to avoid intimacy and not talk about the problem.

6) Ignorance of the definition of alcoholism or addiction.

Stereotypes of the "typical" alcoholic or addict, myths, even one's own experience with an alcoholic can lead to excluding one's own behavior from the definition. For example, an individual can say:
I don't drink or use every day
I do my school work
I never drink in the morning
I don't crave, or need to drink or use
I don't drink or use much when away from school during Xmas, summer, etc.

7) Toxic effects of AOD on the brain

Addictive AOD use seriously disrupts the normal functioning of the brain, not only causing dysfunction in the action of "feel good" chemicals (neurotransmitters such as dopamine and serotonin) thereby causing craving and loss of control, but also cause dysfunction in the brain's ability to process, store, and use information.

8) Inconsistency of patterns of AOD use, loss of control and consequences.

The individual may not get drunk every time, may not suffer negatives every time, may be able to quit for a time, etc., and will, of course, focus on the times when nothing bad happened.

9) Influence of media and culture.

Society, commercials, ads all depict alcohol as an integral part of life's activities---sports, good times, bad times, sex, etc. Not drinking is in many parts of society abnormal.

10) Sneaky disease.

The loss of control over, and addiction to, drugs and alcohol are insidious in their onset and development.

11) Stigma.

Alcoholics and addicts are considered by much of society to be weak willed, immoral, irresponsible, and even criminal. Persons who have this disease also tend to internalize this stigmatized notion of the alcoholic or addict, and tend to not only resist applying such a term to themselves, but also resist seeking help because, perhaps, they feel unworthy.

12) Professional enablers.

Even today, when persons with AOD addiction seek help, they often encounter care givers with little expertise in diagnosing and treating AOD disorders, who provide services not directly addressing the addiction. This approach enables the addicted persons to rationalize that they are getting help that may result in a return of the ability to use.

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