Denial: A Sincere Delusion
When someone crosses the line into addiction, what others see is denial. Like me, when I insisted I wasn’t an alcoholic at a blood-alcohol that would kill the average rhinoceros, addicts consistently reject any suggestion they might have a problem. One study reported that an astounding 94% of those classified drug- or alcohol-dependent denied they needed treatment.1 Another indicated that only 1.2% of America’s approximately 7.4 million adults with untreated “alcohol abuse disorder” thought they could benefit from treatment.2
Why can’t drug abusers see what everyone else in their lives sees — that drugs have turned them into slaves and will kill them?
As active addicts are among the least trustworthy people, the unlikely answer is sincerity.
Rehab defined denial as “a sincere delusion.” Counselors instructed us it was necessary to separate the truth of a belief from the certainty of its truthfulness; people can genuinely believe things that aren’t objectively true. Addicts’ belief that they need drugs to survive is fallacious, but their faith that it’s true is unshakable. It’s based on the depth of the emotional memory that drugs are the solution, so they can’t be the problem.
It’s easier to see someone else’s irrationality than your own. It’s almost impossible to see it in yourself, we were instructed, especially when your addict brain works overtime to make sure you don’t. It reminded me of the last joke in Annie Hall. A guy goes to a psychiatrist and says, “My brother’s crazy. He thinks he’s a chicken.” The psychiatrist asks, “Why not have him committed?” The guy replies, “I need the eggs.”
Addicts genuinely believe they need drugs to survive. And it’s true, at least in the short-run. (To late-stage addicts, there is no long-run.) It was rational in its perverted way to start my day with a half-pint of vodka. It was the only way to stop the shakes, settle my stomach, dull the headache, and calm the anxiety. So to an addict, it’s entirely rational to continue to use, illustrating how the addict brain can employ rationality in defense of insanity.
My family and friends could never understand that. Their solution was to take away the medicine I needed to be normal. They could never conceive how huge a threat sobriety was, proof positive that they didn’t understand my world. Or worse, confirmation they didn’t care. They said my only true friend was my enemy. I knew better in every atom in my body.
Denial is just another way of saying you’re too terrified to contemplate what a fleeting insight into your own drug problem means. Thus unnerved, your brain refuses to let you continue to go there. Because what it means is you have to quit and there isn’t anything scarier than that in the entire cosmos. Quitting means the end of the world as you know it. It means the end of your very self. It can’t even be imagined, like trying to project what the world would be like if the laws of physics didn’t apply. (For more click on The Terror of Withdrawal and Detox: Emotional)
Though addicts would never admit it, the rational mind doesn’t simply roll over. It chisels out small chinks in the wall of denial. Even if part of the rational mind has been co-opted, the rest of the rational brain battles back with momentary realizations that something is desperately wrong. But rather than pay attention to this insight, the addict brain responds with Delay: Denial’s Fall-Back Position. As addiction is a progressively worsening disease, eventually denial and delay lead to death.
There are two reliable ways to pierce the denial/delay syndrome. The first is a bottom, an emotional episode so traumatic it crystallizes the life-or-death choice addicts face and evokes a moment of clarity. Only then can an addict see clearly enough to surrender to the irrationality of addiction. Crucially, a bottom compels action, whether going to an AA meeting or acquiescing to rehab, as was my case. But a bottom by itself doesn’t impel instant sobriety. It makes you surrender to addiction and seek help. After that there’s a lot of hard work to do. But you don’t have to do it alone.
The second reliable way to perceive denial is by getting sober and looking back on all the insane things you did when you were using. This is re-enforced every time you hear an addict’s First Step story, his history of drug use, whether in rehab or at AA meetings. When you see flagrant denial in others it’s easier to catalogue it in your own. It’s an “Oh, I did that too,” moment.
Without a bottom or sober hindsight, expecting addicts to cut through denial and delay on their own is usually fruitless due to the sincerity of their belief that drugs are necessary simply to survive. They’re tragically wrong in this conviction, but until they’re sober they’re practically incapable of seeing it.
They need the eggs way too much.
For more on this topic click on What Neuroscientists Say About Denial.
1. NIH Survey Shows Most People With Drug Use Disorders Never Get Treatment, medicalnewstoday.com, May 8, 2007.
2. Nearly All American Adults With Untreated Alcohol Use Disorders Don’t Think They Need Treatment,medicalnewstoday.com, April 7, 2011.