Beyond Denial: Moving Toward Patient-centered Treatment

The catch 22 of denial is a sacred cow within addiction treatment, yet it serves no meaningful purpose for an individual seeking support.

In fact, the criteria of denial is only brought up when the individual in question states that they do not have a problem. Of course, the real problem here is simply one of perspective. The family member/judge/counselor believes the individual has a problem. They themselves do not.

The criterion of denial is meaningless in the substance abuse setting for a number of reasons. Let’s just use alcoholism for simplicity’s sake.

Issue #1: The Catch 22

Once labeled as to be in denial, you can either admit you’re an alcoholic, and accept your label. Or you can say you are not one, at which point you will still be labeled an alcoholic, but simply one that’s in denial. Either way, you’re an alcoholic. You’re just implying that you have no respect for your patient’s judgement or intellectual capabilities.

Issue #2: It Needs to Be All About the Patient

The second issue is that we all know treatment only works for those who are ready and willing. You cannot force treatment on anyone and be successful.

What someone who is abusing a substance is saying when they say they don’t have a problem is that they’re willing to accept the current problems that come with it.

We cannot and should not assume an individual is stupid or lacks judgement. This is probably what they’ve been told countless times and we only damage the situation further by reinforcing it.

When we pass the irrevocable judgement of denial, we’re saying this individual is not intelligent, they don’t have the ability to make their own choices. In standard 12-step mantra, the drug has taken control.

So we tell them the drug is in control and then are surprised when they can’t seem to take control of their own life? It doesn’t make sense.

Patient-centered Means Accepting and Listening

While the state and insurance companies need clearly defined labels for obvious reasons, to actually help a person using drugs in a way that is destroying their life, we need to take them as they are and seek to understand how they see the issue, not as how we see it. We need a patient-centered approach to treatment.

There is a very clear benefit to substance abuse. Otherwise, no one would do it. Those most successful in recovery often find hope, meaning, and purpose beyond what they’d been able to find before. Helping them find some or all of those three things is the best thing we can ever do to support those in need. Failing to really hear, listen, and understand an individual by slapping the denial ticket on anything they say benefits neither us nor them.

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