Looking in the mirror and accepting what we see can
be one of the hardest things we ever do. It's especially
hard when the image staring us in the face is painful or
doesn't fit with how we want to see ourselves.
Sometimes, the truth is so painful that we avoid it at
Refusing to accept a painful reality that alters the
perception of ourselves is a psychological defense
called denial. As human beings, we may use denial to
protect ourselves from knowledge, insight or awareness
that threatens our self-esteem, mental or physical
health, or security.
The term "denial" is often used in the
chemical dependency field to describe people who deny
substance abuse problems. "Denial is the tendency
of alcoholics or addicts to either disavow or distort
variables associated with their drinking or drug use in
spite of evidence to the contrary," said Patricia
Owen, PhD, a licensed psychologist and Director of the
Butler Center for Research and Learning at Hazelden in
Center City, Minn.
It's a common misconception that all alcoholics and
addicts are in denial. In fact, people have various
levels of awareness of their chemical use problems and
readiness to change behavior. "People may recognize
certain facts concerning their use, such as number of
arrests or how often they drink," Owen said.
"At the same time, they may woefully misperceive
the impact their use has had on the people around them,
their relationships, how they feel about themselves, or
the implications of their drinking history."
Some common statements made by alcoholics who deny
their disease include: "I could quit anytime I
wanted to." "I'd quit using if people would
quit ragging on me." "If you were in my
situation, you'd drink, too." Typically, the more
severe the addiction, the stronger the denial. This is
often baffling and frustrating to family members and
others who care about the addicted person.
"If a person doesn't recognize that his or her
behavior is creating problems, then he or she wouldn't
see the need to change or seek assistance," said
Barbara McCrady, PhD, professor of psychololgy and
clinical director of the Center for Alcohol Studies at
Rutgers University in New Brunswick, NJ. "They are
also likely to react negatively to people who believe
they have a problem."
Also feeding denial is the stigma and shame
associated with alcoholism. Unfortunately, much of
society still perceives alcoholism as a moral failure.
There are many barriers to overcoming denial. In some
cases, the alcoholics behavior may be similar to his or
her peers -- it's hard for them to understand that
anything is wrong. Other people don't think they can be
successful in making changes in their lives, so they
refuse to recognize there is a problem.
Chemically dependent people don't have a monopoly on
denial. The defense is also employed by many people with
chronic illnesses such as diabetes, heart disease,
cancer and AIDS. People with these diseases may use
denial to avoid accepting their mortality, giving up
fantasies of control or invincibility, or dramatically
An article in the Dec. 14, 1994 issue of the
"Journal of the American Medical Association"
notes that "denial may constitute a barrier to the
patient's sharing of essential information; it may also
interfere with the patient's ability to hear and accept
medical advice." Examples of denial include not
reporting chest pain or other potentially
life-threatening symptoms and denying the impact of
chronic or disfiguring illnesses.
It is a myth that harshly confronting a person with
the consequences of his or her behavior helps people
break through denial. "In most cases, it builds up
the defense even more," Owen said. "People
fear coming into treatment because of the shame and
stigma associated with alcoholism; they fear rejection
and confrontation and facing up to their guilt and low
self-esteem. A more effective way is to help people
learn more about their disease and get support from
others who also have the disease."
Family members can help by allowing the chemically
dependent loved one to experience the consequences of
his or her drinking or drug use. "If someone passes
out in the yard -- unless it's a life-threatening
situation -- they should be left there," McCrady
said. "The person will begin to recognize that
there are consequences for his or her actions. If family
members give feedback, it should be when the person is
sober or straight and it should be expressed in a caring
rather than confrontational manner."
Alive and Free is a chemical health column created
by Hazelden Foundation, a nonprofit agency that provides
a wide range of services relating to alcohol and drug
dependence. Address questions to Alive and Free Editor,
P.O. Box 11, BC 10, Center City, MN 55012-0011 or email
to Marty Duda.