Denial may be the single biggest obstacle in getting treatment for addiction, and it is certainly a source of huge frustration for those close to the addict. Denial, essentially, is the addicts inability (willful or otherwise) to assess the extent of his or her own problem with drugs. The addict’s delusion is expressed in two self-told lies” “It’s not that bad” and “I can handle it myself” despite ample evidence to the contrary.
A corollary to denial is rationalization, which the addict uses to explain, to himself and others, why the consequences of his drugging are in fact attributable to other factors—bad luck, ill will on the part of others, the wife, the job, society, etc. When rationalization and denial are operative, the addict is locked in a state of unawareness about his true condition. This state, unfortunately, usually requires a high degree of emotional pain in order to break through and create an opening for a more accurate self-assessment.
The term anosognosia means “lack of awareness” or “lack of insight” regarding one’s own condition. Although it is used mainly in conjunction with psychiatric disorders like schizophrenia and bipolar disorder, anosognosia can refer to addict denial when it reaches the level of pathological.
For treatment professionals, dealing with denial begins with assessing its extent. Different addicts have different levels of self-awareness in terms of their drugging problems, and their readiness to change is usually linked to that level of awareness. It bears noting that the more severe the addiction—the longer it has been present and the greater the amount consumed—the higher the level of denial usually is. This could be the result of either or both of two things: first, the greater the dependency. the greater the inevitable discomfort of withdrawal, so denial serves as a self-protective mechanism against future pain; and second, denial may be the result of damage to the prefrontal cortex. When denial is high and the addict is still submitting to treatment—often as the result of some external threat of loss, or of an intervention—treatment professionals’ primary job after detox is to break down the denial complex.
It is generally acknowledged that, without an accurate self-assessment in terms of the dangers of continued drugging and its consequences, an addict’s chances of achieving and maintaining recovery are minimal. Breaking through denial is the first step in recovery.