I never cease to be amazed at how certain some people are that they are not addicted to a substance. But I also understand that this is a typical and important symptom of addiction. It is what we call denial.

Denial is an unconscious defense mechanism. Defense mechanisms are an important part of the psyche; they operate to keep us on an even keel emotionally and to protect our self-esteem. We all use them. Two examples are repression, which allows us to exclude painful or conflicted memories from our consciousness, and sublimation, which allows us to act out unconscious fantasies in socially useful ways. And there are many more.

Denial is seen in a variety of circumstances but occurs in a specialized form in addiction. Basically, a person in denial continues to maintain that an obvious reality is not true. While addiction is developing, the user desperately wants to continue to manage moods with a substance. It’s like getting caught between a rock and a hard place. On the one hand, you probably know a lot about the particular dangers of your drug of choice, be it alcohol, marijuana, cocaine, or something else. But on the other hand, you cannot envision living life without the option of changing your mood.

You might fear that you could never again enjoy socializing or that you would become overwhelmed by depression or anxiety. You might bury such a fear so deeply that you don’t even know it’s there. But you have a persistent feeling of hopelessness about ever being able to stop using. One way to manage this inner conflict is to slowly but steadily distort your perception of reality so that you can convince yourself that it is okay to continue using. This is denial.

“I can quit any time I want to” is denial in a nutshell.

“I can quit” is a denial of the reality of the addiction; “any time I want to” is a rationalization. It is an example of the dishonesty that creeps in as addiction develops. The truth of the matter is that you really don’t want to quit. You are addicted. You may want to learn how to drink or use drugs and avoid the negative consequences, but you don’t want to quit. The addiction is serving a lot of important psychological functions at this point and giving it up involves changing the way you live.

Denial can be subtle or extreme. The longer the addiction is present and the more severe the consequences, the stronger it gets. I interviewed a man at a treatment center who had had five DUI arrests, had lost his job and family, and had been ordered by the court to get treatment. Our conversation went something like this:

It says here in the chart that you have had over five DUI arrests. Is that correct?

Oh, yeah [laughing]. And they’ve picked me up for public
drunk, too. Probably five or six times.

I see. Did you lose your job because of your drinking?

No. They let me go because I was late for work.

But you were late because you were hung over?


Your wife left you last year. She has sole custody of the kids, right?

Yeah. I can see them with the social worker. But I don’t want to.
They don’t care about me anyhow.

She left because of your drinking?

[Angry] No! That woman left me because she’s a control freak,
and I’m not about ready to let any woman control me.
So none of these things have to do with your drinking except the

DUIs and the public drunks?

Nope. And just because you get a DUI doesn’t mean you’re
an alcoholic. Heck, anyone could get a DUI the way things are

You’re not an alcoholic?

No, ma’am.

So what are you doing here in a treatment center?

Look. I’m just here because my lawyer told me the judge would
go easy if I went to treatment. You know, I’ll have to do jail time
for this last DUI.

Yes, I know that. Do you think it might be wise to stop drinking?

I can stop. I’m not an alcoholic.

Denial separates the awareness that a negative consequence has occurred from the emotional impact it should have. In order to accomplish this, you begin to place blame outside yourself. It wasn’t your drinking too much at the bar that resulted in the DUI; it was the overzealous cops. It wasn’t your being hung over or undependable that made the boss upset; the boss was being unreasonable and demanding.

Smoking is a good example. There has been a massive publicity campaign in recent years to educate the public about the dangers of smoking. But a smoker who is confronted with the health risks is likely to say, “Gotta die somehow. Might as well die happy.” This really isn’t slow suicide, as some people believe. It is denial.

Elizabeth Connell Henderson, M.D.



Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information

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