The Power of Denial by Ed Hughes
We frequently use the word “denial” in our description of a person’s inability to admit to their problem with drinking or drug use. We might say a person is “in denial,” meaning they are being dishonest with themselves and others, or that for whatever reason they are unable to see the obvious.
Denial is actually a very common human characteristic, not at all reserved for people with problems relating to addiction. Denial is the common tendency to reject information that is contrary to the way we would prefer to view things.
The rejection of unwanted facts, so that we can keep thinking and behaving the way we want. Sometimes these unwanted facts come from our minds, such as when we see something we really want to buy at a store, but then we hear our own minds say that we can’t afford it. But rather than listen to this inner voice, we begin to argue with ourselves (rationalize) until we come up with an acceptable justification for moving ahead and doing what we want to do.
Have you ever heard of someone bringing home a boyfriend or girlfriend that mom and dad didn’t like? I asked this question in a public meeting one time and a woman raised her hand and said, “I sure did, and I married him. And mom and dad were right,” she joked, with her embarrassed husband sitting next to her.
What is the normal reaction of the person told by mom and dad that they don’t approve of the boyfriend? The reaction is certainly not to agree with mom and dad and end the relationship. No, it is usually an argument about how they are wrong (defending), and in cases where perhaps one is not able to argue with mom and dad, then maybe sneaking to see the boyfriend/girlfriend will be the choice. In any case, we are not very accepting of information that flies in the face of what we really want. This is part of being human.
Now, what happens when this normal human experience called denial comes in contact with something as powerful as drug addiction? What happens is the addicted person becomes mentally blind to the reality of their situation and unable to see the destruction their disease is inflicting on them and others. To the world the addicted person looks terribly selfish, inconsiderate, manipulative, and dishonest. But these are only symptoms of the addicted person’s increasing disconnection with reality. Addiction acts like a filter on the person’s brain, filtering out advice, logical suggestions, and truth. The denial process eventually creates an inability for the addicted person to make reasoned choices, or accurate self-awareness in the form of insight into what is happening to their life.
All of this is very frustrating to family, friends and community. It seems impossible to “talk any sense” to the addicted person. Denial is a powerful barrier to admitting the presence of a problem and getting help. In order to get well, there needs to be at least a small chip in the wall of denial. This is usually created when the consequences of addiction are experienced by the addicted person, rather than others. Consequences become the opportunity for helpful information to get through, making an impact which in turn can create the beginning of recovery. Denial will begin to diminish if and when the person becomes abstinent from all drugs of addiction, and denial will continue to diminish as a recovery process is initiated.
It is also common for loved ones to experience denial. It is very difficult for a parent, friend or spouse to fully accept the realities of someone’s addiction. Most often this denial is removed in layers, with the first layer being recognition that your loved one is addicted and needs help beyond your own ability to help. Breaking through denial also means breaking through our reluctance to ask for help. This first step can be a powerful one on the road to recovery, if the loved ones continue to challenge themselves to deal with their own faulty thinking and need to accept the realities of addiction.
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Ed Hughes is one of the originators of the Loved Ones Group. He is a licensed, Independent Chemical Dependency Counselor for the State of Ohio, and served as Executive Director of The Counseling Center, Inc., from 1989-2013. He also served as CEO of Compass Community Health from 2013-2016. Mr. Hughes earned a B.A. in Sociology from Ohio University and a Master’s of Public Service Counseling from Western Kentucky University, and has written a companion book titled Baffled by Addiction.
An interview with Ed Hughes, MPS, LICDC-CS
Drug addiction has had a devastating effect on our community and families. What would you recommend to an addicted person or family member who is looking for a good and effective treatment program?
I would begin by measuring any treatment program by the standards of the National Institute of Drug Abuse( NIDA). NIDA identifies several important characteristics of a good and effective program.
First, you want a program that views addiction as a treatable brain disease that left untreated eventually impacts every aspect of a person’s life. Understanding addiction as a disease allows the addicted person, and their family, to embrace a solution that is based on proven medical science, as well as an understanding that treatment should address the individual’s physical, emotional, social and spiritual challenges.
Secondly, there is not one single treatment solution that fits everyone. An effective treatment program will offer a variety of treatment options focusing on the complex needs of each addicted person. An addiction assessment should focus on determining the appropriate level of care for each person. Treatment options should include outpatient, intensive outpatient, residential, transitional and aftercare services, and on-going relapse prevention support. These treatment options vary by level of frequency and intensity. Residential treatment is the highest level of care offering the person an opportunity to live in a closely monitored and structured environment outside of their own home. Aftercare services address the chronic nature of this disease by offering counseling and support for as long as needed to ensure a stable foundation and maintenance of sobriety and independence. Most all addicted persons initially underestimate the level and amount of treatment support they need. It is very important that any treatment center have the ability to increase the level of care as needed.
Next, you need a treatment program that addresses the multiple needs of each addicted person. The addiction to the drug is a primary concern, but ongoing recovery may well depend on the level of attention paid to other problems, i.e., mental health issues, need for continuing housing support, assistance with finding a job or engaging educational services. There must also be a comprehensive approach to addressing other health care needs. Most addicted people have not paid adequate attention to their primary care needs and many in addiction treatment are diagnosed with other serious health problems. Failure to address these co-occurring health issues can dramatically affect the potential for success.
There are medications that can assist in the treatment of addiction. These medications are intended to “assist” in the treatment of addiction by reducing the intensity of withdrawal symptoms, or helping to reduce drug cravings. These medications can be effective when provided within a comprehensive counseling and health care program. However, I would recommend avoiding programs that rely primarily on medication, such as Suboxone, offering limited counseling, health care, or other support. These programs are often attractive to the addicted person who is seeking a simple, or quick and easy solution. Recovery from addiction is not simple, nor quick and easy. I am also not supportive of programs that think medication is part of a program for all addicted people. Medication is not an effective tool for many addicted people. I also favor a short-term use of Suboxone as it is itself an addictive drug. Since Suboxone is an addictive drug, long-term use presents the dilemma of how to withdraw the person from the medication. I believe this can be best accomplished earlier in the treatment process when the person is engaged in intensive services and surrounded by greater support to avoid relapse.
I strongly believe that an effective treatment program makes every effort to include families in the treatment of their addicted loved one. Too often families are left out of the treatment process, which not only misses a tremendous opportunity to educate and develop the family as a helping resource, but it also leaves the family vulnerable to continued manipulation by the addicted person.
Lastly, but just as important as anything I have previously mentioned, you want a treatment program that takes a very active approach to linking clients to community 12 Step recovery programs, Alcoholics Anonymous and Narcotics Anonymous. These programs are vital to the long term maintenance of sobriety, and provide explicit directions regarding the development of good character and the healing of damaged relationships. Addiction is a chronic disease with no cure. Lifelong abstinence is possible when the addicted person is equipped with the tools and support for daily maintenance of sobriety.
If a person is addicted to one drug can they safely use other drugs as long as they avoid the drug that has gotten them in the most trouble?
No. Addiction is a brain disease. Continued use of other mood-altering drugs will lead to an addiction to those drugs or will lead the person back to their original drug of choice. The ability to control ones drug use is the obsession of every addicted person. Switching drugs is a common attempt in continuing the pursuit of the “high” while avoiding the consequences created by addiction. A primary goal of recovery is to embrace the need and desire to attain, and maintain, abstinence from all mood-altering drugs.
To this end, frequent drug testing is another characteristic of an effective recovery program.
What happens if someone relapses after a period of sobriety?
Relapse is an issue with any chronic disease, similar to a recurrence of cancer, or when a diabetic deviates from their diet and exercise plan. Relapse is a common reality for those making their initial efforts to get clean and sober. The potential for relapse and the steps to take to get back on the right track must be a big part of the counseling process. An effective treatment program will work hard toward relapse prevention, but will also help prepare the addicted person, and their family for the potential of relapse. Most people in long-term recovery have benefited from multiple episodes of treatment.
Are treatment agencies licensed by the state or other governing organizations?
Yes, and I would highly recommend asking any program you might use whether they are licensed by the Ohio Department of Mental Health and Addiction Services, or have a national certification such as CARF (Commission on the Accreditation of Rehabilitation Facilities). This can assure that the program is following certain best practices and standards, and is subject to regular reviews and audits.
What about the cost of treatment?
There are a lot of variables regarding the cost of treatment, but first let me point out that addiction treatment is, in most cases, very affordable when compared to other health care services. However, families need to be very careful when considering payment for addiction treatment. As I mentioned previously, most successfully recovering people have experienced multiple episodes of treatment. It is wise to seek advice from a local, certified and licensed treatment agency before committing financial resources to a treatment plan that may have been selected by the addicted person.
A certain consideration is to select a treatment provider that accepts health insurance as a payment for services, and avoid those that are “cash only”.
What does recovery look like?
A recovering person has accepted the realities of their disease and has taken personal responsibility for his or her life. Taking personal responsibility will involve not only abstinence, but also efforts to become a fully functioning, independent person who is working to heal broken relationships, addressing continuing emotional, health and spiritual issues, and using their experiences to help others. There are many, many people in long-term recovery who are making a significant contribution to their family, employer, church, and community.
Are you hopeful the community is making progress in dealing with our addiction problems?
I am very hopeful and certain that people can enjoy a full and joyful recovery from drug addiction. I witness people getting well and putting their lives back together. I am blessed to see families rejoice in the sobriety of their loved ones. I am also realistic. We have never been faced with a epidemic in our community so devastating and broad as this opiate problem, and as difficult as the prescription drug problem has been, the heroin problem is worse. We must remember that we are all in this together, the addicted person, their family, those trying to treat the addicted person, the health care community, law enforcement, churches, employers….we are all working together to heal our community, one person at a time.