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There are certain terms, related to substance use disorders, that are universally recognized by people.

These terms are part of pop-culture and even people outside the recovery echo chamber are aware of what they stand for.

Terms like “tough love” and “hit bottom” are 2 examples.


Another term associated with substance use disorder is the term “denial”.

He is in denial. She needs help but she is in denial.

People throw the term denial around but I’m not sure they even know what the label means. Are you saying the person is not aware of the problem?

Because, technically, that is what denial means.

From a psychological perspective, denial is a technical term (developed by Freud; refined by his daughter Anne Freud).

The ego utilizes denial to “block reality” because the individual (technically the id) can not handle the reality. It shuts out evidence.


Psychology Today puts it this way:

“when you use denial, you simply refuse to accept the truth or reality of a fact or experience”.

Perhaps denial would apply to a person in the beginning stages of alcohol use disorder.

The socially acceptable aspect of alcohol use would make denial possible. The slow progression would make denial possible. Perhaps someone in the beginning stages of cannabis use disorder.

Again, there is a process and progression that may make denial more likely.

Maybe cocaine use disorder. Early on. Probably the beginning stages of prescription opioid misuse.

But I am of the opinion that “denial” is not the issue for many of the people who receive the label “in denial”.

Many who are “not getting help” are quite aware they have a problem.


Do you actually think a person addicted to heroin is in denial?

Do they “have no awareness” of the desperation of their situation?

Or methamphetamine or crack cocaine? Or the “alpha alcoholic” who is drinking himself or herself literally “to death”.

They are quite aware that they have “a problem and need help”.


We can not solve problems if don’t accurately identify the problem we are trying to solve.

The assumption of “denial” sets up a societal response that borders on cruel. The assumption of denial leads to the assumption that “hitting bottom” is the only way to “break through denial”.


  • The issue is not denial.
  • The issue is readiness to change.
  • The issue is motivation to persevere.
  • The issue is access to service.
  • The issue is lack of alternatives and options for recovery.
  • The issue is unaddressed underlying trauma.

But its not denial.


As professionals our job is to find ways to solve those problems listed above.

Not to wait for the “breakthrough of denial”.

As a society our job is to put money into research for alternative solutions. We need go beyond the mere funding of a relatively narrow scope of practice.

A system that deals with less than 10% of the people with this particular healthcare issue.


If there was only one medicine for cancer, and it was rejected by 90% of those with a cancer diagnosis, what would our societal response be?

There would be riots in the streets, followed by a massive amount of money focusing on drug development and alternative therapies. The government would pour money into research.

The American Cancer Society’s coffers would overflow. Celebrities would demand action.

But where addiction is concerned, 90% reject the only medicine available, and we call them “treatment resistant”.


We tell them, and their families, they are in denial.

Let them hit bottom. Let them experience pain and we can then breakthrough denial.


You can not work for, or volunteer, with FAVOR Greenville if you believe people need to hit bottom and break through denial.

We will work with you to help you gain an understanding of the change process.

We will be patient if you are making an effort toward true multiple pathway work.

But if you can’t get there we will politely and cordially part ways.


It is our core belief that people get better in the context of a loving and compassionate relationship.

And, although there are times when circumstances dictate hard boundaries, connection is the opposite of addiction.

Connection will bring more people into the recovery process than breaking through denial.

We are seeing this play out everyday.

The post Confronting Denial – What Does That Mean? appeared first on RecoveryCartel.com.

Source: Recovery Cartel