The Role of Denial in Addiction

Denial is a key obstacle to recovery.

Posted Nov 13, 2018

Denial plays an important role in addiction. Addicts are notoriously prone to denial.  Denial explains why drug use persists in the face of negative consequences (Pickard, 2016). Addiction cost them their job, their health, or their family. If they remain ignorant about the negative consequences of their actions, then these consequences cannot guide their decision-making.

Rational beliefs are formed on the basis of solid evidence and are open for appropriate revision when new evidence makes them less likely to be true. It is now well-established that we are prone to various cognitive biases that have powerful influences on how we make decisions. For example, the confirmation bias causes people to embrace information that confirms their pre-existing narratives. People hold certain beliefs (often unconsciously) in part because they attach value to them.

The terms denial (or repression) can be defined as selective ignoring of information. Denial is a refusal to acknowledge the reality of one’s situation. Denial is a form of motivated belief or self-deception that detaches an individual from reality (Bortolotti, 2010). To maintain a positive view of themselves, people revise their beliefs in the face of new evidence of good news but ignore bad news. Psychological processes such as distraction, forgetfulness, and repression, may serve as a variation of denial. It should be noted that these psychological processes may or may not be conscious processes.

The psychodynamic perspective suggests that denial is basically a defense mechanism (McWilliams, 2011). That is, individuals with substance disorders use denial in order to prevent threatening emotions entering our conscious thought. Lacking the capability to cope with negative states, they will erect powerful, sometimes intransigent, defenses in a desperate effort to avoid feeling them. Keeping the unacceptable feelings out of awareness result in the development of a “false self.” The price for this protection is the inability to seek out help. For instance, an alcoholic dismisses that his or her excessive drinking is a real problem.

Addiction can also be a source of terrible shame, self-hatred, and low self-worth. For an addict, it can be terrifying to acknowledge the harm one has done by one’s addiction to oneself and potentially to others one cares for. When they are high, their fears of inadequacy and unworthiness fade away. Users often report a sudden dissociation from self. For example, alcohol and heroin are often sought for their numbness.

Admitting the negative consequences requires one to end the behavior causing these consequences. But the quitting itself will bring pain and distress. Denial, therefore, protects a person against this negative experience by denying the reality of one’s situation, when doing so would cause such psychological pain and distress. 

There is also evidence suggesting that addicts lack the knowledge about the negative consequences not out of denial, but because of impairment in insight and self-awareness (Naqvi et al., 2007). Chronic drug abuse has been recognized to be associated with impaired self-awareness (dysfunction of the insular cortex), which manifests as denial of the severity of addiction and the need for treatment. For example, only a small fraction of heavy drinkers admit they have a drinking problem. This is a reason why some people keep drinking even as they realize that the habit is destroying their lives.

Addicts also fail to care for the future. Addicts are temporally myopic. That is, the future consequences are not weighed in comparison with the present benefits. The benefits of drug use may be clear and immediate, while the costs are typically delayed and uncertain. They tend to prefer drugs because, at the moment of choice, they value drugs more than they value a possible but uncertain future reward (e.g., health, relationships, or opportunities).

In sum, denial is central to the explanation of why addicts persist in using despite evidence of harmful consequences. The anxiety associated with thinking about the consequences may in some circumstances lead addicts to repress or deny, news about their addictions. Denial alleviates anxiety. Acquiring causal knowledge of the negative consequences of drug use must, therefore, be seen as an important step in recovery. Indeed, the first step of Alcoholics Anonymous is to admit that you have a problem and begin to seek out help. Since individuals use denial to protect themselves from psychological pain, the substance abuser needs to be given new tools for coping effectively with that pain.

References

Bortolotti L. Delusions and Other Irrational Beliefs. Oxford University Press; Oxford: 2010.

McWilliams N (2011). Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process (2nd edition). New York, Guilford.

Naqvi, Nasir H., David Rudrauf, Hanna Damasio, and Antoine Bechara (2007). Damage to the Insula Disrupts Addiction to Cigarette Smoking. Science 315: 531-534. 

Pickard Hanna (2016). Denial in Addiction. Mind and Language, Vol 31 (3): 277-299.