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Denial and Drug Addiction, A Serious Problem

Allan N. Schwartz, LCSW, Ph.D. Updated: Nov 19th 2008

 This November, 2008, The Society for Neuroscience had their annual meeting in Washington D.C. The theme of the meeting was "Impaired insight into illness in Drug Addiction." Many scientists in the fields of neurology and drug addiction shared their findings. Those findings show that the same parts of the brain involved in schizophrenia are affected by drug addiction. What is especially significant about this is that those brain regions impaired insight or awareness about how one is being affected by their own behaviors.

In the case of drug abuse, the impaired insight causes what is referred to as "denial." One definition of denial when applied to drug abuse is "not recognizing the severity of the disorder." In denial, it is as if a person cannot see the problem standing directly in front of them. It's like "having your head in the sand." In other words, the addict will assure everyone and themselves that they are not addicted, can stop anytime and have full control over what they are doing. By the way, this includes those who chronically use marijuana. Here, I am referring to chronic use as daily and all day long.

It is now thought that craving the drug, feeling compelled to use and chronic relapsing into drug abuse after recovery, may all result impaired insight. In other words, these drug addicted patients have a difficult time recognizing, accepting and admitting to the signs and symptoms of the addiction they suffer from.

When you come right down to it these researchers are reporting that these patients are blind to what their bodies are trying to tell them.

Those of us who work with patients in the field of addiction, find this denial to be the most frustrating and aggravating aspect of working with the addictions. Just to be clear, the entire topic of addiction includes alcohol just as much as all of other drugs from marijuana to methamphetamine.

In my experience, it is amazing to hear someone who spends their entire time inebriated report that they are perfectly fine.

It is hoped that this recent research about insight, brain regions and denial will lead to new treatments.

What are your experiences with either drug abuse or living with a loved one who suffers from drug abuse?

Allan N. Schwartz, PhD

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

Reader Comments
Discuss this issue below or in our forums.

finding a crack in the denial wall - bill - Jul 3rd 2012

ive known her for over two years,a mother of two,and ive tried over and over to make her look in the mirror of life.on a daily basis she abuses some type of drug and its almost like she has no memory of what happened in the hours of the day,it amazes me how she thinks everything is fine.although she continues to make it on in day to day situation,and because of this,there seems to be no end in sight.her father had some sort of brain disorder before his passing, so this topic makes me think im trying to help her but no matter what i do or say, no connection is possible.

My faith tells me to hold on - Torrey - Dec 25th 2010

We have been together for 2 and1/2 years. He was on an alcohol detecting bracelet and sober for the first 4 months. Then after completing that he began U.A.s  and passed those. Later got caught with 1.82 breath alcohol level (B.A.)one early afternoon in a probation meeting after a night of heavy drinking and little sleep. Had to go back on bi-monthly U.A.s as well as B.A.s. He would stop drinking 2 days before a U.A. (ETG) and 10 hours before a B.A. Once he failed a random B.A. then he was ordered to take DAILY B.A.s He still drank everyday. Starting an hour or 2 after the B.A. and stoping around midnight. He can show self control but can he kick this addiction? People say only when he is ready to do it, BUT how do I help? What do I say without offending him? He knows I love him. I have spent too many nights over the past year, alone and crying and praying. He has told me many times that he wants something better for himself and for us. His entire family and friends all drink and party nearly everyday. I want to be a positive influence in his life. He had issues with meth in 2004-2006 and completed a 2 year inpatient treatment program. I met him after he had been free for 6 months and clean for 2 years. I'm afraid he may be using meth again. his social group had changed and many of these people are known addicts. He has lost 15-20 lbs in the last 90 days. He is so distant and unsure of everything. I had my own experience with alcohol and meth when I was much younger. I have been clean for 11 years. I drink maybe a dozen times a year. I miss my friend, my lover, my heart. I want to help him. I don't know what the truth is anymore :-(

Anxiety - - Aug 4th 2010

I have a loved one who is in denial about his anxiety.  How do I help him understand that he has a problem and that I'll be there to help him with treatment?

Dimethocaine - Otto Sanders - Jul 29th 2010

Do you know Dimethocaine? I've employed it, and it's not undesirable. It actually worries me that users of cocaine are going to utilize this as a alternative. They should not. It's a distinctive stimulant that actually has to be treated with respect if you don't want to overdose from it. This is possibly the closest issue to a cocaine substitute, at least in terms of effect and duration, that I've tried.

I hope that significant warnings are issued along with the sale of this. It's type of wonderful for occasional use, but that's it. On my own opinion the only advantage, like cocaine and procaine, it ought to have the neighborhood vasoconstricting properties which, is really great for occasional intranasal use as it prevents a genuinely rapid flood into the total system, which must aid to limit toxicity (the same way it aids cut down cocaine toxicity- even though it's very damaging for long term use).

denial advice - - Jan 26th 2010


Not necessarily - Laura - Jun 7th 2009

Is it "denial", or is it protective lying to busybodies?

I was well aware of my drinking problem.  I did not deny it.  I knew something was terribly wrong, and I said so.  It was the people around me who were "in denial" and would invalidate me when I claimed I had a problem.  (If I have a problem, what do they have?)

So here's at least one person who was NOT "in denial".  I've heard other people who had drink or drug problems say the same thing.  They knew perfectly well what was wrong.  There are plenty of us who are NOT "in denial".

Just have to be careful whom you admit things to, that's all.  You're likely to get punished instead of helped.

Repackaging AA philosophy - Ray Smith - Jun 7th 2009

AA claims that denial was proof of addiction.

Not according to Lorraine T. Midanik, author of  "The Philosophy of Denial in Alcohol Studies: Implications for Research".

Midanik refers to an alcoholic hiding how much he or she drinks as "lying", not denial. When a person is accused of anything, the accuser causes the accused to become defensive.

On the Neuroanthropology weblog, Daniel Lende, has a facinating article, "Denial".

He responds to a commenter:

"I like these sorts of examples because they show denial as something people in general do, not something specific to addicts because of some psychodynamic or prefrontal cortex problem. I suggest you look at Motivational Interviewing as a way to work with everyday issues of denial–empathic listening and rolling with resistance help you get closer to the other person, and thus overcome the initial denial that everything might be all right."

The Reality - - Feb 25th 2009

The reality is just as has been stated on the blogs and other areas concerning the use of addictive drugs.  The user remains in denial they are addicted and have developed methods of justifying the use, good for pain.  i live with an older male user who is moody and can be very childish , moody, verbally abusive, and just shut down when without marihuana. The truth is just as all have has to be addictive, it causes the breakdown of relationships, and basically renders the user unmotivated to fulfill promises, and not to mention it becomes the love of their life, no a relationship with others.

nothing - - Nov 23rd 2008

nothing on narcissistic people or men

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