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So you don't think that you are an alcoholic. Chances are that you are not, but this is the thought that many who are unknowingly addicted to alcohol or other mind-altering agents. This denial barrier is the first of many hurdles to overcome when they are identified as having an addiction disorder. Although all denial isn't bad most of the time, addicts are often the last to recognize their disease, pursuing their addictions into mental illness, the degeneration of health, and ultimately death. This paper will explain the concept of denial, its consequences, and the implications it has for nursing care.

Review of Literature and Knowledge Base

What is denial? Dr. Hilary Knatz, the author of Getting On, states that ?Denial, is a way of coping with unpleasant realities? (Knatz, 1999). She then goes on to explain that:

Denial, in the psychological/psychiatric vernacular, is a defensive strategy to minimize anxiety. It is defined and conceptualized in a number of ways, which differ according to theory. In classical Freudian terms, denial is a defense mechanism invoked by a person when there is a danger that he or she will become aware of or act on unconscious primitive impulses that are unacceptable. We defend against such impulses, it is said, by unconsciously limiting our awareness of them, or perhaps attributing them to others. A murderous rage, for example, may be repressed or obscured from our awareness, or it may be attributed to others (p. 2).

The Oxford English Dictionary defines denial to be 'the asserting (of anything) to be untrue or invalid; also, the denying of the existence or reality of a thing? (Simpson & Weiner, 1989).

Sometimes denial can be constructive and adaptive, according to R. Davidhizar, V. Poole, J. N. Giger, and M. Henderson the authors of When your patient uses denial. For example, there have been studies of people with terminal illness that have suggested that denying the seriousness of the condition may help postpone death. It is true that overwhelming anxiety can hamper coping, and that screening out anxiety-provoking stimuli can help prevent this kind of paralysis. In general, it must be observed, the world is full of terrifying possibilities that we could never completely comprehend (1998).

Denial is the refusal to believe or accept the reality that certain events have happened, are happening, or will happen. To accept the reality would bring emotional pain, so the events are denied. Related to denial is the defense called minimizing. Events are accepted, but only in a watered down version. ?Sure I drink once in a while. Everybody does. It's no big deal. Once in a while I might get carried away, but it really isn't a problem? (USDHHS, 1994).

Denial is the primary psychological symptom of addiction. It is an automatic and unconscious component of addictions. Addicts are often the last to recognize their disease, pursuing their addictions into mental illness, the degeneration of health, and ultimately death. Sadly, many addicts continue to act out on their addictions while their world collapses around them blaming everything but the addiction for their problems (USDHHS, 1994)

Denial is one of the reasons that recovery from addictions is seldom effective if the chemically dependent person is forced into treatment. You cannot work on a problem unless you accept that it exists (USDHHS, 1994).

Active alcoholism and addiction are characterized by a struggle to control use. Addicts resent the suggestion they are powerless until things get so bad they are forced to face their addiction. Sadly, some alcoholics never break through their denial, and continue use to the point of insanity and death (USDHHS, 1994).

The concept of denial plays a key role in the twelve-step addiction treatment model, where denial of addiction is seen to be the chief hindrance to any kind of realistic treatment of the problem. This is no easy task because addicts have developed an ?elaborate network of denial? (McCracken, 1998). Not only of addictive events, but also of the meanings and consequences of those events, whose seriousness they try to minimize with rationalizations (McCracken, 1998).

The twelve step programs also recognize that any one person's denial can expand into a group denial, most immediately, perhaps, to the family system. Family members play along with the addict's behavior, assume the addict's guilt, and maintain a secretive united front with the outside world (McCracken, 1998).


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