What Drives It?
“Damn! It’s 2 o’clock in the morning, and I’m still awake.”
“You’re awake because that thing deep inside keeps gnawing at you.”
“Oh no, not you again!”
“Yeah, it’s me, what’s left of your conscious.”
“Ah crap. Leave me alone.”
“Nope, can’t do that. You and I are in this together. I want to see you get out of this addiction. But, you gotta’ do some work.”
“All I want to do right now is get a pipe and kick back.”
“Spoken like a true addict. But, I’m going to pester and pester you till we get this thing settled.”
“Ah crap.” (Takes a deep breath.) “OK, OK, what do I gotta’ do?”
“You damn well know what you gotta’ do. You gotta’ come to terms with IT.”
“No …, no! I not ready for that.”
“Bull… Take a deep breath. Turn and take a look at it. That feeling has been messin’ with you for years. You know as well as I do it’s not that you deny you have a problem. You’ve known that for years. It’s that other thing that holds you back from getting sober. You try to drown it out, but it won’t go away. Time to face it buddy. Ready?”
(Takes another deep breath.) “I’ll try… I feel it. It’s getting closer. I don’t know if I can do this.”
“I can feel it too. Stay with it. You’re almost there. Now say the words.”
(Pause) “I’m afraid. Damn it, I am afraid!”
“Hold on, just a few more steps. What is it that you’re afraid of?”
(Pause) “What will they think of me? Damn, it’s what people will think of me, knowing all the really bad things I did in my addiction. I’m so afraid… I just want to run away and hide.”
(Period of silence) “But, you didn’t run away or turn your back on it. That was a very big step you just took. It’s called coming to terms with yourself. And, it’s a big step toward recovery.”
Don’t think for a moment that it’s always denial that holds people back from sobriety. Sometimes it’s fear. And if it is, that fear will drive what looks to be denial. Fear needs to be addressed in a manner that befits such a strong emotion. The same can be said for shame, guilt, and even self-deprecating thoughts.
Find what drives denial and engage that.
That Forced Feeling
Angry teenager (AT): “Go ###k yourself. You can’t tell me what to do.”
Exasperated counselor (EC): “Look, you broke a rule. You have to follow the rules around here, just like everyone else in this program.”
AT: (Seething silence)
EC: “All this angry, and ‘stick you heals in’ behavior just shows how much you resist coming to terms with your addiction.”
AT: “There you go again. Now you’re telling me how I’m supposed to think. I
can’t win around here.”
(Angry teenager starts to cry.) “How would you like it if someone told you what to do all the time? That’s the way I feel. Do this. Do that. It’s all I heard growing up. I’m sick and tired of it.”
On hearing that rant an old memory flashed from the counselor’s past. It reminded her of how her overbearing father would tell her what to do, day in day out.
The angry teenager words were almost identical as were the counselor’s when she was a teenager. Like cold water in her face, it almost took the counselor’s breath away. She felt that old anger swell deep inside again. How she hated being told what to wear, who she could be friends with, and how she was to conduct herself.
After years of frustration, the counselor recalled how her father one day decided to include her in making her own decisions. He later said to his daughter, “This isn’t getting us anywhere. And I don’t like how I feel.”
So, he stopped commanding and began talking with his daughter. He showed genuine interest in his daughter’s needs. They soon discovered they could come to decisions, which they both agreed on. To the delight of both of them, the anger and the ‘stick your heals in’ behavior between them began to melt.
The counselor had forgotten all about that time. She pondered it for a time, thinking how she might do the same thing to the angry teenager.
EC: Approaching the teenager, the counselor said, “Can we talk?”
AT: “Now What?”
EC: “If it was up to you, how would you have handled the rule your broke?”
AT: Looks up with a surprised look on her face.
EC: “I’m serious I would like to know.”
The two began to talk.
There are a lot of client behaviors that look like and quack like denial, but such things are not really hard-nosed, down in the dirt, denial. This example happens to be called reactance. Tell someone what to do, and quite often they will “resist” and get really angry. Besides reactance, other ‘denial look alikes’ include ambivalence, anti-social personality disorder, residual physiological effects of substances, and others. Each has a resemblance to denial and each can be mistaken for denial. Such ‘look alike’ behaviors need to be differentiated for what they are. Once truly identified, treatment needs to be conducted in the relevant manner, and according to the individual needs of the client. Not all addiction clients are in denial. They very well might be exhibiting something that appears to be denial, and mistakenly appraised as denial. Such appraisals do nothing to really help clients.
Frustrated counselor (FC): “Man, that group was a bear today. Everyone one was in denial. No one is making any change. They just screw up over and over.
Seasoned counselor (SC): “Sounds like you had a tough one today.”
FC: “I don’t know what it is with these guys. I think they’re old, been drinking for years and the denial has buried itself deep in their brains.”
SC: (Pause) “Ya’ say their old, and been drinkin’ for years?
FC: “Yeah, that’s about it. A couple of them admitted to drinking for over 30
years. Can’t they see what’s it’s doing to them? Stubborn ol’ geezers.”
SC: (Pause again) “I used to work with guys like that. For a while, I thought like you. Old timers who drank for decades were just embedded in denial. Then I went to this workshop, and found out these guys have brain damage. Seems they can help themselves; can’t seem to learn from their mistakes. Made a difference in the way I treat folks like that.”
FC: “So, what you’re trying to tell me is that guys like this are not actively opposing treatment? They got brain damage and that’s what makes them act the way they do.”
SC: “Yeah, that’s about it.”
FC: “I’ll be damned. I never thought about that. I got to consider this.
Maybe try something different next time.”
SC: (Just smiles.)
There are those clients, through the course of their addiction, who have sustained sufficient brain damage from substance abuse that the executive function of their brain can no longer make quality decisions. Their circuits are blown. Such folks appear to be in denial, but are not. While they make the same mistakes over and over again, the reason isn’t denial, it’s the brain damage. And, you treat brain damage differently from the way you treat denial. Above all, the cardinal rule is not to confront those with brain damage, especially doing the harsh confrontation stuff. That creates needless agitation, and may well be unethical. What this crowd needs is cognitive rehabilitation and more understanding.
Mike Taleff has written a number of books for addiction professionals and over 100 articles. He lectures at Leeward Community College in Hawaii, and conducts workshops nationally and internationally. He can be contacted at email@example.com.