Denial in Alcohol Use Disorder

Research suggests that denial may be experienced by people with alcohol use disorder. It can often prevent someone from seeking help.

But not everyone living with alcohol use disorder experiences the same level of denial, if they experience it at all. Your loved one may be aware of some of the effects of alcohol use, but not of others.

Some people may think alcohol use does not affect them at all. Others may be at a point where they know they need to make a change.

There are many forms of denial. Below are some common forms and examples.

Rationalization

The person with alcohol use disorder may try to justify their behaviors or offer reasonable alternatives to why something happened.

For example: “That wasn’t because I was drinking. The fog was so thick I couldn’t see.”

Blame

When confronted, they may try to shift the blame.

For example: “Well, if you had put the bottle away, I wouldn’t have thought to drink it.”

Dishonesty

When you’re worried about being judged or confronted about something, honesty can take a back seat. It may be easier for the person with alcohol use disorder to hide the truth than to be honest about their drinking habits.

For example: “I wasn’t at the bar. I stopped to run some errands on my way home.”

Defensiveness

You may find they become defensive when the subject of alcohol use comes up.

For example: “I didn’t do that. You always think I’m drinking.”

Comparing situations

In an attempt to rationalize behavior, you may notice they compare their behavior to someone else.

For example: “Well, Jane just got caught drinking on the job. If I had a problem, wouldn’t I have gotten fired?”

Being dismissive

When you bring up drinking around someone living with alcohol use disorder, they may act as though your concerns are trivial.

For example: “Oh, that’s silly. You just worry too much.”

Avoidance

Sometimes, it may be easier for your loved one with alcohol use disorder to avoid talking about it completely.

For example: “Let’s not talk about that now. Did you see the latest on the president?”

There are several reasons a person might hide or deny they have alcohol use disorder. Some common ones include:

• not understanding the condition or recognizing symptoms
• feeling guilt or shame
• fear of change

Other reasons include:

• social stigma, or the idea that people with substance use disorder are to blame for their condition or “flawed” in some way
• lack of education, leading people to believe that those with substance use disorder just need to “make better choices”

No matter the reason behind your loved one’s denial, help is available.

Could it be anosognosia?

Denial is not the same as anosognosia, a condition where someone refuses to believe they have a medical condition despite ample evidence.

Unlike denial, which is a coping mechanism, anosognosia is the result of changes to the frontal lobe of the brain.

Anosognosia is commonly associated with other mental health conditions, such as:

• schizophrenia
• dementia
• bipolar disorder
• major depressive disorder
• hemiplegia

Understanding denial is a first step toward helping your loved one with alcohol use disorder. When you realize denial is a coping mechanism, you may feel less frustrated with the behaviors you’ve seen.

Here are other ways to help a loved one who is experiencing denial:

• Don’t make excuses. You want to protect those you care about, but covering for someone living with alcohol use disorder prevents them from experiencing the negative consequences of their actions.
• Express concerns in a supportive manner. Denial can cause your loved one to avoid or become combative about treating alcohol use disorder. By using supportive, positive ways to express your concern, your loved one may be more open to realizing how their behaviors affect others.
• Prepare professional options. Denial is a deep-rooted defense mechanism that may require professional intervention to overcome. Having options available, such as local support groups or counselors, may help your loved one seek care sooner rather than later.

It’s important for you and others involved in helping your loved one to understand and view alcohol use disorder as a long-term health condition, just like you do high blood pressure or diabetes.

If you or someone you know is living with alcohol use disorder, there are a number of resources that can help.

The NIAAA Alcohol Treatment Navigator is a great tool that provides more information about alcohol use disorder, how to find treatment, and how to find support.

You can also visit the NIAAA Rethinking Drinking website or read the NIAAA treatment guide to learn more about alcohol use disorder and to find help for your loved one.

The Al-Anon Meetings group locator can help you find support groups that meet in person or online.

If you’re seeking help for a teen, you can check out resources from the Family Resource Center or the Partnership to End Addiction.

Not everyone who has alcohol use disorder hides or denies they misuse alcohol.

But if you or someone you know is showing signs of denial, don’t feel discouraged. Help is available and recovery is possible.

Talking with someone you trust can be a useful first step. You might also find it helpful to talk with a counselor or therapist who specializes in alcohol use disorder.

An expert can advise you on next steps.