Addiction is the one disease that seems intent on keeping the inflicted convinced that they don't have a problem.
It is a sneaky disease, working with its partner, denial, to further its insidious goals. The smoker has a persistent cough, but swears he'll quit next week, after his big presentation to the board of directors. Things will be too hectic till then. After another lost weekend, the opioid addict pops more prescription pills, telling herself she'll stop after this nagging phantom pain subsides. And the alcoholic can stop whenever he wants, he tells himself. But now, one more night out won't hurt. It's the holidays, after all, or he needs to take the edge off, or friends are in town... and the cycle continues.
"You can quit later," denial tells us. But for many, later never comes.
The power of denial is illustrated by the case of Sam (not his real name), an alcoholic who had his abdomen drained of fluid in February because of advancing liver disease. Long a "functional alcoholic" who went to work every day to provide for his wife and daughters, Sam had begun looking 20 years older than a normal 53-year-old, his muscle tone withered and his belly distended. Once a standout high school athlete and avid surfer, vital enough to run his own construction business for more than 30 years, a single glance in the mirror should have told him that something was very wrong.
Denial is one of those funny little coping mechanisms. It is not unique to addiction although it comes in very handy -- if you're addiction, that is. You see, most human beings are under the delusion that we do not need to worry about tomorrow because tomorrow is so far in the distance. Today we wait for the ushering in of this brand new sparkling tomorrow with its ideal arrival fallacy. It's a handy tool for a disease that commandeers volition. The joke is that it's the alcoholic who is the last to learn he or she is an alcoholic. The truth is too painful and even more inconvenient for a habit whose uncanny ability at self-propulsion puts it in a class all by itself.
Hanging Tough in Denial
Sam should have known that alcohol was killing him. Yet when his doctors told him he had to quit drinking, but shouldn't detox without medical assistance, all Sam heard was, "Don't quit cold turkey." He recognized he had to stop drinking, eventually, but he kept hitting the bottle, though more stealthily, apparently telling himself it was for maintenance purposes and consistent with his doctor's orders. For now, it was more important to go back to work. Despite overwhelming evidence to the contrary, he decided he could quit later, when it was more convenient.
Sam landed back in the hospital in June, less than four months later, with end-stage liver disease. At this point, his only hope for survival is a liver transplant, which he may not live long enough to receive.
Yet Sam remains in denial. He is plotting ways to go back to work, though he can barely walk across the room, and wavering on rehab. He believes his family wants him in recovery because they want him out of the house.
Denial is a core symptom of substance use disorders and getting past it is step one in AA's 12-step program. Alcoholics have seemingly endless excuses for their behavior. "It's not a good time to stop," is classic. So is, "no one is going to tell me what to do," "I suffer from A, B and C and drinking helps me cope," "I'm not that bad," and the list goes on.
How to Help
If Sam's story resembles that of anyone you know, here are some ways to motivate an addict to get help.
- Talk about the problem without blame or judgment.
- Stop hiding the problem from close friends and family members. Ask for their help and support.
- Let your loved one know how his drinking or drug use has affected what he cares about most: children, career, financial stability, etc.
- Don't preach or lecture. Create a two-way dialogue so the person doesn't feel badgered.
- Sometimes an intervention is needed to convince a person he has a problem. The National Council on Alcohol and Drug Dependence reports that when done by a trained professional, an intervention results in more than 90 percent of people making a commitment to get help.
Perhaps the most important thing to do is instill hope. Recovery is possible. I found my calling after a personal struggle with alcohol and am living proof that there is a better life after addiction. My goal has been to change the face of addiction treatment by offering not only sobriety, but a life full of positivity, engagement, strong relationships, achievement and purpose -- a mind-boggling transformation for an active addict to envision.
Don't stand by and watch your loved one self-destruct. If his or her "tomorrow" never comes, compulsory treatment may be an option. Many states now allow for involuntary commitment for addiction and research shows that treatment works even when it is entered into unwillingly.
Sam's denial will likely be his undoing. Don't let your loved one stare down death before you reach out for help.
Jason Powers, MD, is an addiction blogger and chief medical officer at Promises Austin substance abuse treatment center and The Right Step network of drug rehab programs in Texas. He is the pioneer of Positive Recovery, an approach to addiction treatment that helps people discover meaning and purpose in their lives.
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.