What to Say to An Addict In Denial: Erasing Shame and Encouraging Treatment

Denial is universal. “Everyone alters reality somewhat by perceiving events in accordance with our personal biases,” says Darlene Lancer, a marriage and family therapist. “Denial helps us cope with a potential threat or uncomfortable facts and feelings. We also deny reality when the truth would put us in conflict with someone else or ourselves.” Indeed, denial can at times be an important strategy to keep us from crumbling under the weight of reality, particularly when dealing with situations we can’t control.

Denying addiction is simply another articulation of the denial everyone experiences all the time; people struggling with addiction rationalize, minimize, repress, self-deceive, and selectively forget in order to avoid confronting the unbearable reality of their own substance use disorder. This process may be conscious, unconscious, or often both, particularly as substance use itself diminishes their aptitude for accurate self-perception. The deep stigma attached to addiction and its possible consequences can make denial particularly appealing since admitting addiction, either to themselves or others, comes with a host of painful implications, whether true or not. If I am an addict, I am a bad person. If I am an addict, I do not have control over my life. If I am an addict, I will cause my loved ones pain. If I am an addict, I have to go to treatment, cut off my friends, and give up the substance that is helping me cope.

But while people struggling with addiction may have unique impetus for denial, some experts believe the notion that addicts’ denial is fundamentally different than other types of denial does a disservice to both addicts and their families. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) publication, Enhancing Motivation for Change in Substance Abuse Treatment:

Engaging in denial, rationalization, evasion, defensiveness, manipulation, and resistance are characteristics that are often attributed to substance users. Furthermore, because these responses can be barriers to successful treatment, clinicians and interventions often focus on these issues. Research, however, has not supported the conclusion that substance-dependent persons, as a group, have abnormally robust defense mechanisms.

In fact, the authors suggest that the pathologization of normal defense mechanisms in substance-dependent individuals may be counterproductive when attempting to guide someone into treatment. By working from the belief that addicts’ denial exists outside the spectrum of “normal” coping strategies, this pathologization may only increase defensive responses. “Essentially, [it] becomes a self-fulfilling prophecy.”

There is a common myth in the recovery community that addicts have to hit rock bottom before they seek treatment. That idea, however, is not only false but dangerous. The truth is that many, if not most, people seeking addiction treatment are compelled to do so at the urging of their loved ones rather than an independent desire for recovery. This fact alone tells us that denial is often not the impenetrable shield it is sometimes believed to be; it is possible to guide people into treatment even if they did not previously admit the need for it.

Unfortunately, the concept of pathological denial keeps many people from productively intervening.

For a number of reasons, the treatment field in the United States fell into some rather aggressive, argumentative, ‘denial-busting methods’ for confronting people with alcohol and drug problems. This was guided in part by the belief that substance abuse is accompanied by a particular personality pattern characterized by such rigid defense mechanisms as denial and rationalization.

However, as the National Institute on Drug Abuse (NIDA) points out:

There is no evidence that confrontational ‘interventions’ like those familiar from TV programs are effective at convincing people they have a problem or motivating them to change. It is even possible for such confrontational encounters to escalate into violence or backfire in other ways.

Indeed, adversarial confrontation that relies on bullying and shaming a person into treatment is unlikely to be successful, in part because it naturally activates the exact self-defense mechanisms it is attempting to remove. Instead, intervention should seek to create a safe space free from shame and blame in order to prevent defensive responses and open up authentic conversations about your loved one’s drug use.

If breaking through pathological denial is not the primary project of intervention, what is? Experts now believe constructive confrontation that works by enhancing motivation is the best way to guide addicts into treatment. According to SAMHSA:

From this perspective, constructive or therapeutic confrontation is useful in assisting [addicts] to identify and reconnect with their personal goals, to recognize discrepancies between current behavior and desired ideals, and to resolve ambivalence about making positive changes.

In other words, the focus is on dissipating self-defense mechanisms and presenting treatment as a way for them to achieve their own goals. In order to foster this kind of intervention, it’s important to thoughtfully consider what to say to your loved one. The following strategies can be helpful:

• Use “I” Statements: “I” statements such as “I was worried” or “I feel” help prevent accusatory language that can alienate your loved one.
• Be Specific: Talk about specific behaviors, situations, and incidents that demonstrate the impact of their addiction in order to help them see how their substance use is negatively affecting them and the people they love. This does not mean making a laundry list of complaints but rather is an opportunity to show how their drug use is keeping them from their true desires.
• Avoid Shame or Blame: Addiction is a chronic brain disease, not a character flaw, and it cannot be cured by shaming or blaming your loved one.
• Ask What They Want: No one dreams of being an addict, but in the midst of addiction it can be difficult to remember the dreams you once had. By asking your loved one what they want out of life, you can help them reconnect to their goals and explore how continued substance use interferes with those goals. This can incentivize recovery and provide newfound motivation for change.
• Talk About Their Fears: Admitting addiction can be scary, but talking through those fears with your loved one can give them the opportunity to examine them with greater clarity, often helping them identify their irrationality or find strategies for overcoming them.
• Offer Support: Tell your family member that you love them and are there for them. Ask them what they need in order to help them overcome addiction.

While some people attempt to intervene on their own, it is best to have a professional interventionistpresent who can help you plan the intervention to optimize the chances of success and provide support for your whole family. As NIDA says, “Often people will listen to professionals rather than have conversations with friends and family, as the latter encounters can sometimes be driven by fear, accusations, and emotions.” A professional interventionist can work closely with both you and the treatment program in order to transfer your loved one into care immediately following the intervention, allowing your family to begin healing at last.