“Denial ain’t just a river in Egypt” is a humorous quote often attributed to Mark Twain. In psychology, denial refers to a defense mechanism, first postulated by psychoanalyst Sigmund Freud, in which a person faced with a fact too uncomfortable to accept rejects it instead, denying its veracity despite the possibly overwhelming evidence.
In the disease of addiction, denial is foundational and the polar opposite of acceptance. The ability to deny or minimize is essential to allow a person in active addiction to continue their self-destructive behavior, which appears highly irrational to outsiders. They cannot comprehend why the addicted person continues to use despite the many negative consequences. In order to sustain a successful recovery from addiction, denial has to be overcome. Accordingly, the reversal of denial informs many steps in 12-Step programs.
Steps one and two ask addicted people to accept that they are powerless over drugs and alcohol, that their lives have become unmanageable, and that a power greater than themselves can restore them to sanity. They have to admit that their substance misuse has become a serious problem.
Unfortunately, a large number of patients entering residential addiction treatment lack that kind of acceptance. “It’s natural for human beings to reject things that hurt them,” says Dino Liverano, the clinical manager of the men’s program at Lakeview Health. “It’s somewhat counterintuitive to accept things that have been so damaging because you’re acknowledging them in a way you’re not used to. We see a lot of people who are not ready to accept that they have an addiction problem.”
One reason for this is what addiction professionals call “external motivation.” “People who are externally motivated come to rehab because of legal problems or similar reasons,” explains Sarah Franklin, the clinical manager of the women’s addiction treatment program, The Rose of Lakeview. “They may want to get out of a DUI conviction. Others are trying to save their marriage after their spouse gave them an ultimatum, or an employer found out about the substance use disorder and demanded they go to treatment or lose their jobs.”
This type of motivation is not based on acceptance and does not augur well for the patient. “They might think they can do a quick detox and be done with it,” says Franklin. “Patients come in because of those external reasons but don’t really accept they have a problem that has caused so much destruction in their life.”
Accepting that you have an addiction and that you cannot continue using alcohol or drugs requires internal motivation, a genuine change of mind.
Most addicts have been numbing emotional pain for a long time. Acknowledging that fact in recovery is not easy for people with addiction, especially if they are used to suppressing or controlling their feelings with substances.
There are things in life that the individual will not be able to change. Addiction is a chronic disease that cannot be fully reversed. A return to the days before the addiction is not possible. Realizing that should not be an excuse for giving up, though. Recovery from addiction is possible. The trick is to change the things that should and can be changed.
The Serenity Prayer sums up the dilemma: “God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”
Lakeview aftercare coordinator Lexie Leehan is in recovery herself. “When I finally understood acceptance, it took a huge weight off my shoulders. I was able to accept whatever was going to happen, knowing that I was going to be okay, no matter what.” Accepting the disease of addiction for what it is and committing to work on getting better often brings great relief to people in early recovery.
Unfortunately, most people with addiction take a dangerously long time to accept their condition. Often, the path from denial to acceptance leads through a number of distinct stages.
Acceptance in recovery from addiction can be understood as analogous to the acceptance stage in the five stages of grief introduced in 1969 by Swiss-American psychiatrist Elisabeth Kübler-Ross in her groundbreaking book On Death and Dying.
As in grief, the first stage is denial as the addict clings to the notion that he does not have a substance abuse problem. He also erroneously believes that he has complete control over the situation and can stop drinking or using drugs whenever he wants.
Another popular form of denial is attributing the reasons for the substance use to other people. “Many addicted people want to blame their drug and alcohol use on circumstances,” says Leehan. “They will say, this situation happened to me because of unfortunate circumstances or because this person in my life did this to me.”
When doubt arises that the addicted person is actually in control, anger follows. The addicted person vehemently rejects the idea of being dependent on drugs and alcohol and reacts with anger and frustration. In order to pacify those negative emotions, she misuses drugs and alcohol in ever higher doses. Once the substance misuse escalates and addiction develops, the anger and frustration intensify.
In the bargaining stage, alcoholics and drug users try to convince themselves or others that they are going to stop using in order to avoid trouble or save a relationship. They might now admit they have a problem but still think they can negotiate their way out of it. They might try to bargain with their Higher Power (God, I promise to never use again if you just get me out of trouble this one time) or with a loved one (If you let me stay here, I will never do drugs or alcohol again).
“Many don’t want to accept that they can never drink alcohol or do drugs again in their life, because that seems too hard for them,” says Leehan. “They’d rather say, if I could just fix what’s going wrong with my life, if could get a better job or make more money, I wouldn’t be as stressed and wouldn’t drink as much. But of course, it’s not any of those things; it’s just the disease of addiction.”
In the depression stage, the addicted person loses all hope of ever getting better. He realizes he is hooked and cannot see a way out. This is a very dangerous exacerbation. Often, people with addiction overdose or hit bottom at this point. If the afflicted person survives this crisis, she might finally arrive at the final stage where she no longer denies her condition, accepts it unconditionally and seeks help.
This is the crucial moment that prepares the ground for recovery. Although it is a kind of surrender, it is far from capitulation. “A lot of the surrender the 12 Steps ask for is really about acceptance,” says Franklin. “It’s about accepting help from your Higher Power and from other people.”
“Recovery is a big paradox,” says Leehan. “You accept where you are even though it’s not where you want to be. One of the first steps in recovery and improving your life is to admit that you’re powerless, which is actually empowering.”
“Patients recognize that powerlessness isn’t always a bad thing,” says Liverano. “When they first hear about being powerless, they think it’s scary because it makes them vulnerable. But when you accept you’re powerless over certain things, you also realize there are things you can change. That is what we are looking for in therapy, to be able to realize what you have control over and work on that, and, at the same time, accept the things you cannot change.”
Patients also need to accept who they are. “Self-acceptance is a really big part of the recovery process,” says Franklin. Self-loathing is common among people in active addiction as the negative consequences of the compulsive substance use pile up.
Self-hatred is also often caused by trauma. Many people with addiction were sexually assaulted as children or experienced other forms of horrific violence. “They often believe if they ignore the trauma, it will make them more resilient, but that’s not necessarily the case,” says Liverano. “Most of the time it is much healthier to accept that the trauma happened and is now part of them.”
Because of the strong correlation between trauma and substance use disorders, trauma-informed care is an important part of addiction treatment. Lakeview Health specializes in treating addiction and many co-occurring conditions like PTSD, anxiety, depression, and chronic pain simultaneously. All staff at Lakeview have been trained in trauma-informed care, and patients can also benefit from gender-responsive treatment.
Acceptance is at the beginning of the long recovery journey. Recovery is much more than just abstaining from substance use. Recovery can lead to emotional sobriety, which can be described as the ability to deal with difficult feelings in healthy ways that do not involve abusing drugs and alcohol in an effort to self-medicate.
The American philosopher William James once said, “Acceptance of what has happened is the first step to overcoming the consequences of any misfortune.” Without that first step, all the other necessary steps to overcome addiction are unlikely to follow.
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