Denial is a characteristic distortion in thinking experienced by people with alcoholism. For decades, people who treat alcoholics, and recovering alcoholics themselves, have puzzled over why alcoholics continue to drink when the link between alcohol and the losses they suffer is so clear. Denial is an integral part of the disease of alcoholism and a major obstacle to recovery. Although the term “denial” is not specifically used in the wording of the diagnostic criteria, it underlies the primary symptom described as drinking despite adverse consequences.
Mark S. Gold, M.D. is the Chairman of Rivermend Health’s Scientific Advisory Boards. He serves as Chairman of the Addiction & Psychiatry Scientific Advisory Board and also as the Chairman of the Eating Disorders and Obesity Scientific Advisory Board. He served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014. Dr Gold was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Editor: Nadeem Noor
Treatment professionals are beginning to recognize that not all individuals with alcoholism have the same level of denial. In fact, people have various levels of awareness of their alcohol use problems, which means they are in different stages of readiness to change their behavior. Professionals have taken advantage of this insight about alcoholism to develop treatment approaches that are matched to a person’s readiness to change and that motivate people to enter the change process even when they are frightened of what’s in store. However, despite these advances in treatment, many individuals with alcoholism persist in denying their problem, and typically, the more severe the addiction, the stronger the denial.
The power of the alcoholic’s denial may be so strong that it carries over to the alcoholic’s family and important people in his or her life, convincing them that the alcoholic’s problem is something other than it is—weak health, bad luck, accident proneness, depression, a tendency to be preoccupied and worried, a mean temper and countless other possible problems.
Many adults young and old have experienced a shock of recognition when they look back over their childhood and realize that their mother or father, a beloved grandfather or a family friend was an alcoholic. No one talked about it; everyone covered it up. The stigma of alcoholism and the many myths that have merged to form a distorted portrait of people with alcoholism have strongly contributed to denial both on an individual and a societal level. The hope of health professionals and others who have worked to educate the public that alcoholism is a disease and not a defect of willpower or a moral failure is that, now and in the future, fewer people will have to experience this shock of recognition when it is too late to do anything about it, and that people will get the treatment they need when they need it most—before alcoholism has led to irreversible consequences.
When people close to an alcoholic are affected by their own and the alcoholic’s denial, they often act in ways that protect the alcoholic from experiencing the full consequences of his or her behaviors. This type of protective behavior, although often motivated by love and concern, is referred to as enabling, because it permits the individual to continue drinking and allows the disease to progress, the symptoms to intensify and the consequences to become worse for all concerned. Like denial, enabling is another one of the symptoms of alcoholism—a symptom displayed by others, not by the alcoholic—that is not specifically mentioned in the diagnostic criteria, but that is a well-recognized aspect of the disease. Special groups, like Al-Anon and Alateen, have been established to help people concerned about the alcoholics in their lives to understand them and to help them, largely by gaining the strength to stop enabling. Overcoming denial and enabling is often the first step into treatment for the alcoholic.