It has become a cliché that people with substance use disorders will initially be in denial that they have a problem at all. Their substance abuse then seems to become your problem, as you try to get them to acknowledge what seems obvious.
In order to help someone in denial, it’s important to understand what substance use disorders (SUDs) are, how they lead to denial, and what you can do to help your loved one face their problem so they can go on to get the treatment they need.
What are the signs of a substance use disorder (SUD)?
If you believe that someone you love has a SUD, there are several symptoms to be mindful of:
- Productivity or attendance changes at work or school.
- Increasing problems with the law.
- Sneaky or suspicious behavior.
- Changes in sleeping or eating patterns.
- Changes in personality (mood swings, irritability, anger, etc.).
- Periods of high levels of activity, often accompanied by a giddy or euphoric mood.
- Decreased motivation.
- Unexplained fears, paranoia, or anxiety.
- Weight loss or gain.
- Declining physical appearance, including hygiene.
- Bodily tremors, changes in speech, and lack of coordination.
- A change in friends, hobbies, and favorite places to hang out.
- Financial problems, including sudden requests or demands for money.
The more signs your loved one shows, the more likely it is that they have a substance use disorder. But before you decide to discuss it with them, you must understand what a substance use disorder is on a fundamental level.
How substance use disorders take over the brain
It’s important to remember that a SUD is a chronic brain disease, not a lack of willpower or self-control. Because of repeated drug or alcohol use, your loved one’s brain has essentially been rewired so that it demands their substance of choice.
This is how it works:
- Alcohol or drugs spark a rise of dopamine in your brain.
- Under normal circumstances, your brain would return to production of dopamine at your personal base-level; however, the more you use drugs or alcohol, your brain rebounds to below what’s considered normal, leaving you feeling depressive symptoms when you don’t use.
- Over time, you develop a tolerance to higher levels of use, but not to the lows that come afterward, so you start using drugs or alcohol not to experience a high, but to avoid the withdrawals that come from not
Dopamine isn’t just related to pleasure. It is present in the parts of the brain that regulate movement, emotion, thinking, and motivation. Your loved one’s brain has probably physically changed, too, especially in the areas related to judgment, making decisions, learning, memory, and controlling behavior. Remembering these facts will help you understand the causes and ramifications of their disorder.
How does a SUD cause denial?
The changes in your loved one’s brain are, at some level, responsible for their denial. To be able to recognize a problem, they would need to have a certain level of self-awareness, which relates both to the ability to think in general and to understand their SUD specifically. Self-awareness rests in the prefrontal cortex, the part of the brain that organizes life experiences into meaning. People with SUDs tend to have structural changes in this area, and their behavior changes as a result: they have problems connecting their substance use to potential or existing consequences to their health, family life, social interactions and daily routine. Essentially, drug and alcohol consumption rewire their brain to deny that anything is wrong with them or what they’re doing.
On another level, denial allows your loved one to continue using their substance of choice. Admitting they had a problem would require action, like starting treatment or getting sober. Since they are so committed to avoiding symptoms of withdrawal, continuing to believe that they have control over the situation and that there are no problems with their life allows them to rationalize their use.
Planning to talk to your loved one
Once you decide to talk with your loved one about their substance abuse, make sure you prepare beforehand.
Try to find out as much as you can about their substance of choice, substance use and abuse, and how it can be dealt with ahead of time. Speak with your doctor about how to best be of help. If you have access to a mental health professional or someone in recovery, those are good sources of information as well. Be sure to ask plenty of questions and listen to all the advice you receive with an open mind.
You can also go to support groups for friends and family of people with SUDs. Al-Anon helps people close to those with alcohol use disorders, and Nar-Anon does the same for people close to drug abusers. Adult Children of Alcoholics/Dysfunctional Families is a good fit for almost anyone, and Co-Dependents Anonymous can help you to develop a healthy relationship with your loved one and others.
Learning about codependency can also be helpful, as it can reveal any enabling behaviors you might have unknowingly exhibited, such as:
- Accepting blame for your loved one’s substance use.
- Drinking or doing drugs with them.
- Rationalizing their behavior or accepting their rationalizations.
- Keeping the peace by denying your own thoughts and feelings.
- Protecting your loved one’s image by covering for them.
- Minimizing their use to yourself or others.
- Taking responsibility for tasks your loved one cannot complete because they’re under the influence, hungover, or absent.
None of these actions will help improve the situation, and learning different coping skills will help you help them.
How to talk to someone in denial
Remember that talking to your loved one about their problem with drugs or alcohol is going to be difficult for you both. With that in mind, be sure to set the stage as best you can for an optimal outcome:
Choose the best possible time and place to talk
Make sure you both are sober, calm, and in a private setting. If something negative has happened as a result of their use, that might be a good time to talk, as they might be more open to seeing the negative consequences of using.
Involve other people
Consider the idea of involving other people in the conversation, including other family members, friends, or an outside source, like a doctor, therapist, interventionist, or faith leader who have experience with SUDs. Talking about this issue can be a huge undertaking and there’s no reason to do it alone unless you believe that a one-on-one conversation would be best for your loved one and that you’re the best person to have this discussion.
A doctor can provide medical facts, a therapist can address underlying psychological factors and has experience dealing with these issues, and a clergy member will often have experience as a confidante. An interventionist, on the other hand, is specially trained to help someone with a SUD listen and accept help from their loved ones. They can help family and friends approach the conversation in a productive and non-threatening way and help incorporate a doctor, therapist, or faith leader if you’d like.
Go into the conversation expecting denial and anger
Remember that there is a neurological basis for their denial.
Keep your emotions in check
Try your best to remain calm and compassionate regardless of what your loved one says or does. Getting into an argument won’t help matters. If things get so heated that the conversation is no longer productive, ask to take a break and try again — either in a few minutes, hours, or days.
Plan out potential responses ahead of time
With the help of your doctor, a therapist, or a support group, plan out what you want to say. Write them down if you need to to keep the conversation focused and positive. Intervention letters are great tools to avoid saying hurtful things during the emotional moment.
Use ‘I’ statements instead of ‘you’ statements
This way, the focus stays on what you’ve noticed, what you worry about, and how you hope to help instead of pointing the finger at your loved one.
Practice active listening
For example, if your loved one starts to deny their problem, minimize it or make excuses for it, try to repeat their statement back in the form of a question to show you understand what they’re saying and to keep them talking.
Decide on what you’ll do if they decide not to seek help
Of course, they may not agree to start treatment immediately after your talk, but if an unreasonable amount of time passes and nothing changes, you need to know what your response will be. Will you remain friends/partners? Will you stay in touch? Will you ask them to move out? Figure out what’s best for you and make sure to follow through on your own self-care.
What not to say or do
There are also things to avoid in the course of this conversation. For example:
- Don’t try to force your loved one to seek treatment. Remember that this may be the first time they’ve truly thought about the scope of their substance use and that it might take time for detox or rehab to seem possible.
- Avoid using the words ‘should/shouldn’t,’ which can seem like you’re telling your loved one what to do.
- Try not to ask questions beginning with ‘why,’ as in “Why do you do this?”, etc. That leads your loved one to feel attacked, which will make them defensive or combative.
- Don’t judge your loved one for behaving in sub-par ways. If they did not have a substance use disorder, they wouldn’t be engaging in these behaviors. Furthermore, they’re probably feeling some shame or guilt about their behavior, and a negative tone could shut down the conversation.
Tips to help your loved one recover
If your loved one decides to accept help, there are ways you can support their recovery without taking it fully upon yourself.
You can tell them about the information you’ve gathered and say that you’re willing to go through it with them or offer to go with them to the doctor or a therapist. If your loved one responds well, you can even suggest exploring treatment options as a team, so they’re not tackling it alone.
Moving into recovery can be a difficult process. Make sure you focus on specific motivating factors that will spur your loved one onward, especially since SUDs are chronic, relapsing illnesses. Don’t set them up to fail, but remind them that a slip along the road to recovery isn’t the end. Emphasize the fact that addiction is manageable, give them positive feedback, and support their progress.
Remember also that denial is the first step in the stages of grief. When grieving people are in denial, they cannot accept that a loss has taken place. Confronting the truth feels impossible. This is a defense mechanism that occurs to avoid pain. The same is true of someone dealing with addiction. Realizing that drug or alcohol use has become a clinical disorder is a harsh reality that may require grieving: for a lifestyle your loved one wants to keep up, for the problems they have caused in their life and in others’, etc. Allow them that time to move past denial while keeping their focus on the good things to come. Soon you’ll both be in a healthier place.
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