There's no such thing as being "in denial"

Among my pet peeves about Dr. Phil-esque beliefs around addiction is the concept that someone who’s addicted to something is “in denial” about his or her addiction.  To be “in denial” means that a person is consciously choosing to ignore the truth his or her addiction.  However, a person who is addicted to something, whether it’s a process or a substance, cannot consciously make the choice to ignore the circumstance.

Again, one of the three (3) C’s of Addiction is, Compulsion.  To review, compulsion is, “compulsion is, “An uncontrollable impulse to perform an act, often repetitively, as an unconscious mechanism to avoid unacceptable ideas and desires which, by themselves, arouse anxiety” (2007, American Heritage Medical Dictionary).    I added the emphasis to underscore the fact that someone who is addicted to something is no longer aware of the behaviors associated with the addiction.

Once the addiction process is triggered, the person literally goes into automatic pilot until the target of the addiction is acquired and consumed.  Until that point, all behaviors occur without conscious thought or choice.  These unconscious behaviors are ritualized; the body begins its preparation for the target through the addiction ritual.  For example, a heroin user usually uses heroin in the same way; that is, he or she has a “rig” that consists of an arm tie to draw veins, a spoon to cook heroin, and a needle to inject the heroin.  He or she usually employs the rig in the same way, every time, he or she injects heroin.  The ritualized pattern of use is referred to as the “setting” aspect of addiction and may involve other people.

However, regardless of the setting, the person struggling with an addiction cannot, by definition, deny the addiction.  It’s as if the person literally “blacks-out” when triggered and doesn’t return to “consciousness” until satiated.  Therefore, I hope and wish and pray that archaic beliefs such as being “in denial” would get thrown out of the Addiction lexicon.  Once that and other myths are gone, perhaps we can all start understanding and working with those who struggle with addictions as people who need healing and compassion, not judgment and shame.

  1. So what you’re saying is that an addicted person is not in denial, because they don’t need to be in denial, because they are in a sense unconscious while performing the act of their addiction – and denial is refusing to accept the reality of something while conscious?

      1. Thank you.
        My husband drinks copiously and frequently. I came home from group therapy yesterday absolutely distraught, and yet he still chose to drink, even though I have told him many times how his drinking affects my mood and mental health. I thought his actions were selfish (I still do) but maybe I ought to be more, I don’t know, sensitive or something, if his behaviour is beyond his control. And yet …. and yet, on some days he does choose not to drink. So why not last night, when I needed him? Sorry! Just thinking out loud here.

        1. My guess is that on those days when he doesn’t drink, he may not be triggered. It sounds like a bit of a loop: You’re distraught; he drinks….he drinks, you’re distraught…alcohol is up there with the most difficult kicks. That is, alcohol causes huge physiological dependence. Couple that physiology with the psyho-emotions associated with compulsion and he’s in a tought joint…

          1. I’m sorry, do you mind if I ask just another question? I want to talk to him this evening about how disappointed I was that he drank last night. I think I’ll draw a diagram of what you wrote above, showing the loop effect. Do you think that will be helpful? Please forgive me if I’m asking too much and feel free not to reply 🙂

          2. i think it would help. the thing is, most people who are addicted don’t really know the when and why they behave the way they do. I do caution you that he may become defensive…

  2. So what you’re saying is that an addicted person is not in denial, because they don’t need to be in denial, because they are in a sense unconscious while performing the act of their addiction – and denial is refusing to accept the reality of something while conscious?