Denial in addiction

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

  • Suggested Resources

    What Is Substance Abuse Treatment? A Booklet for Families
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    It's Not Your Fault (NACoA) (PDF | 12 KB)
    Assures teens with parents who abuse alcohol or drugs that, "It's not your fault!" and that they are not alone. Encourages teens to seek emotional support from other adults, school counselors, and youth support groups such as Alateen, and provides a resource list.

    After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department
    Aids family members in coping with the aftermath of a relative's suicide attempt. Describes the emergency department treatment process, lists questions to ask about follow-up treatment, and describes how to reduce risk and ensure safety at home.

    Family Therapy Can Help: For People in Recovery From Mental Illness or Addiction
    Explores the role of family therapy in recovery from mental illness or substance abuse. Explains how family therapy sessions are run and who conducts them, describes a typical session, and provides information on its effectiveness in recovery.

    For additional resources, please visit the SAMHSA Store.

Last Updated: 08/30/2022

Alcohol, Tobacco, and Other Drugs

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Misusing alcohol, tobacco, and other drugs can have both immediate and long-term health effects.

The misuse and abuse of alcohol, tobacco, illicit drugs, and prescription medications affect the health and well-being of millions of Americans. NSDUH estimates allow researchers, clinicians, policymakers, and the general public to better understand and improve the nation’s behavioral health. These reports and detailed tables present estimates from the 2021 National Survey on Drug Use and Health (NSDUH).



  • Among the 133.1 million current alcohol users aged 12 or older in 2021, 60.0 million people (or 45.1%) were past month binge drinkers. The percentage of people who were past month binge drinkers was highest among young adults aged 18 to 25 (29.2% or 9.8 million people), followed by adults aged 26 or older (22.4% or 49.3 million people), then by adolescents aged 12 to 17 (3.8% or 995,000 people). (2021 NSDUH)
  • Among people aged 12 to 20 in 2021, 15.1% (or 5.9 million people) were past month alcohol users. Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 8.3% (or 3.2 million people) and 1.6% (or 613,000 people), respectively. (2021 NSDUH)
  • In 2020, 50.0% of people aged 12 or older (or 138.5 million people) used alcohol in the past month (i.e., current alcohol users) (2020 NSDUH)
  • Among the 138.5 million people who were current alcohol users, 61.6 million people (or 44.4%) were classified as binge drinkers and 17.7 million people (28.8% of current binge drinkers and 12.8% of current alcohol users) were classified as heavy drinkers (2020 NSDUH)
  • The percentage of people who were past month binge alcohol users was highest among young adults aged 18 to 25 (31. 4%) compared with 22.9% of adults aged 26 or older and 4.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Excessive alcohol use can increase a person’s risk of stroke, liver cirrhosis, alcoholic hepatitis, cancer, and other serious health conditions
  • Excessive alcohol use can also lead to risk-taking behavior, including driving while impaired. The Centers for Disease Control and Prevention reports that 29 people in the United States die in motor vehicle crashes that involve an alcohol-impaired driver daily


  • STOP Underage Drinking interagency portal - Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Interagency Coordinating Committee on the Prevention of Underage Drinking
  • Talk. They Hear You.
  • Underage Drinking: Myths vs. Facts
  • Talking with your College-Bound Young Adult About Alcohol

Relevant links:

  • National Association of State Alcohol and Drug Abuse Directors
  • Department of Transportation Office of Drug & Alcohol Policy & Compliance
  • Alcohol Policy Information Systems Database (APIS)
  • National Institute on Alcohol Abuse and Alcoholism



  • In 2020, 20. 7% of people aged 12 or older (or 57.3 million people) used nicotine products (i.e., used tobacco products or vaped nicotine) in the past month (2020 NSDUH)
  • Among past month users of nicotine products, nearly two thirds of adolescents aged 12 to 17 (63.1%) vaped nicotine but did not use tobacco products. In contrast, 88.9% of past month nicotine product users aged 26 or older used only tobacco products (2020 NSDUH)
  • Tobacco use is the leading cause of preventable death, often leading to lung cancer, respiratory disorders, heart disease, stroke, and other serious illnesses. The CDC reports that cigarette smoking causes more than 480,000 deaths each year in the United States
  • The CDC’s Office on Smoking and Health reports that more than 16 million Americans are living with a disease caused by smoking cigarettes

Electronic cigarette (e-cigarette) use data:

  • In 2021, 13.2 million people aged 12 or older (or 4.7%) used an e-cigarette or other vaping device to vape nicotine in the past month. The percentage of people who vaped nicotine was highest among young adults aged 18 to 25 (14.1% or 4.7 million people), followed by adolescents aged 12 to 17 (5.2% or 1.4 million people), then by adults aged 26 or older (3.2% or 7.1 million people).
  • Among people aged 12 to 20 in 2021, 11.0% (or 4.3 million people) used tobacco products or used an e-cigarette or other vaping device to vape nicotine in the past month. Among people in this age group, 8.1% (or 3.1 million people) vaped nicotine, 5.4% (or 2.1 million people) used tobacco products, and 3.4% (or 1.3 million people) smoked cigarettes in the past month. (2021 NSDUH)
  • Data from the Centers for Disease Control and Prevention’s 2020 National Youth Tobacco Survey. Among both middle and high school students, current use of e-cigarettes declined from 2019 to 2020, reversing previous trends and returning current e-cigarette use to levels similar to those observed in 2018
  • E-cigarettes are not safe for youth, young adults, or pregnant women, especially because they contain nicotine and other chemicals


  • Tips for Teens: Tobacco
  • Tips for Teens: E-cigarettes
  • Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings
  • Synar Amendment Program


  • Truth Initiative
  • FDA Center for Tobacco Products
  • CDC Office on Smoking and Health
  • National Institute on Drug Abuse: Tobacco, Nicotine, and E-Cigarettes
  • National Institute on Drug Abuse: E-Cigarettes



  • Among people aged 12 or older in 2021, 3. 3% (or 9.2 million people) misused opioids (heroin or prescription pain relievers) in the past year. Among the 9.2 million people who misused opioids in the past year, 8.7 million people misused prescription pain relievers compared with 1.1 million people who used heroin. These numbers include 574,000 people who both misused prescription pain relievers and used heroin in the past year. (2021 NSDUH)
  • Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin (2020 NSDUH)
  • According to the Centers for Disease Control and Prevention’s Understanding the Epidemic, an average of 128 Americans die every day from an opioid overdose


  • Medication-Assisted Treatment
  • Opioid Overdose Prevention Toolkit
  • TIP 63: Medications for Opioid Use Disorder
  • Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings
  • Opioid Use Disorder and Pregnancy
  • Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
  • The Facts about Buprenorphine for Treatment of Opioid Addiction
  • Pregnancy Planning for Women Being Treated for Opioid Use Disorder
  • Tips for Teens: Opioids
  • Rural Opioid Technical Assistance Grants
  • Tribal Opioid Response Grants
  • Provider’s Clinical Support System - Medication Assisted Treatment Grant Program


  • National Institute on Drug Abuse: Opioids
  • National Institute on Drug Abuse: Heroin
  • HHS Prevent Opioid Abuse
  • Community Anti-Drug Coalitions of America
  • Addiction Technology Transfer Center (ATTC) Network
  • Prevention Technology Transfer Center (PTTC) Network



  • In 2021, marijuana was the most commonly used illicit drug, with 18. 7% of people aged 12 or older (or 52.5 million people) using it in the past year. The percentage was highest among young adults aged 18 to 25 (35.4% or 11.8 million people), followed by adults aged 26 or older (17.2% or 37.9 million people), then by adolescents aged 12 to 17 (10.5% or 2.7 million people).
  • The percentage of people who used marijuana in the past year was highest among young adults aged 18 to 25 (34.5%) compared with 16.3% of adults aged 26 or older and 10.1% of adolescents aged 12 to 17 (2020 NSDUH)
  • Marijuana can impair judgment and distort perception in the short term and can lead to memory impairment in the long term
  • Marijuana can have significant health effects on youth and pregnant women.


  • Know the Risks of Marijuana
  • Marijuana and Pregnancy
  • Tips for Teens: Marijuana

Relevant links:

  • National Institute on Drug Abuse: Marijuana
  • Addiction Technology Transfer Centers on Marijuana
  • CDC Marijuana and Public Health

Emerging Trends in Substance Misuse:

  • Methamphetamine—In 2019, NSDUH data show that approximately 2 million people used methamphetamine in the past year. Approximately 1 million people had a methamphetamine use disorder, which was higher than the percentage in 2016, but similar to the percentages in 2015 and 2018. The National Institute on Drug Abuse Data shows that overdose death rates involving methamphetamine have quadrupled from 2011 to 2017. Frequent meth use is associated with mood disturbances, hallucinations, and paranoia.
  • Cocaine—In 2019, NSDUH data show an estimated 5.5 million people aged 12 or older were past users of cocaine, including about 778,000 users of crack. The CDC reports that overdose deaths involving have increased by one-third from 2016 to 2017. In the short term, cocaine use can result in increased blood pressure, restlessness, and irritability. In the long term, severe medical complications of cocaine use include heart attacks, seizures, and abdominal pain.
  • Kratom—In 2019, NSDUH data show that about 825,000 people had used Kratom in the past month. Kratom is a tropical plant that grows naturally in Southeast Asia with leaves that can have psychotropic effects by affecting opioid brain receptors. It is currently unregulated and has risk of abuse and dependence. The National Institute on Drug Abuse reports that health effects of Kratom can include nausea, itching, seizures, and hallucinations.


  • Tips for Teens: Methamphetamine
  • Tips for Teens: Cocaine
  • National Institute on Drug Abuse

More SAMHSA publications on substance use prevention and treatment.

Last Updated: 01/05/2023

Addiction denial | Clinical Center "Psychiatry-Narcology"

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  3. Addiction denial

The term anosognosia means the denial of the disease, the lack of criticism of one's condition and is a characteristic symptom of alcoholism. At the same time, even in the later stages of the disease, a person denies the existence of dependence and categorically refuses treatment. Anosognosia is an evolutionarily formed property of alcoholism, which in many ways allowed this pathology to spread so widely. Denial is a psychological defense mechanism inherent in every person, helping the mind to "close" problems that it cannot accept or survive. One of the first to describe the nature of psychological denial was Sigmund Freud. nine0004

Denying the problem and believing that it is possible to give up alcohol at any time is a typical mistake in the thinking of an addict. As a rule, an addicted person can only last for a while, after which alcohol returns to his life again.

Usually an alcoholic decides not to drink for a certain period of time to prove that he has not lost control, for example, under the influence of a promise made to loved ones, or out of shame for what he has done. But anyway, in a month or a year, he will start drinking again. The very essence of the disease is that a person has an illusion of control. nine0004

Denial is the addict's way of preventing himself from realizing reality. It is a way to protect yourself from pain and suffering. Denial is used in order not to meet with painful feelings and experiences, in order not to see the grief of loved ones, not to be aware of the "bottom" on which the user finds himself. Addiction denial is a major roadblock to recovery that needs to be overcome. Therefore, one of the first tasks in recovery from addiction is to overcome denial. Protracted denial is also dangerous because the addict accumulates serious problems, which he stubbornly does not recognize. The life of an alcoholic and his loved ones goes into decline. Social skills and abilities acquired over the years disappear, relationships with other people deteriorate. As a result, it turns out that the problem is growing, and the forces to solve it are less and less. nine0004

The list (though not complete) of denials will surprise you to learn that many of the phrases you hear from addicts are actually just psychological defenses of your drinking.

  • Absolute negation. "I have no problem. I can't be addicted."
  • Minimization. “I don't use that much. I know it's a problem, but it's not as serious as others think."
  • Leaving by denial. “I won't talk about it. I am ready to talk about anything, but not about my addiction. nine0016
  • Shaking care. “I will talk about anything but my addiction, I have more interesting topics to talk about. I can talk you to death."
  • Leaving with the help of a scandal. “You will bitterly regret talking to me about addiction. I will ruin not only your mood, but your whole life if you don’t shut up right now.”
  • Search for a scapegoat. “I use exclusively because of my wife (father, mother, brother, sister, etc.). If you were married to a woman like mine (had a job like mine), you would use just as much as I do.” nine0016
  • Rationalization. "When my use is pointed out to me, I can swindle anyone by arguing for the use."
  • Reference to authority. "Many great people have used drugs, many geniuses have been alcoholics, the use has even stimulated their inspiration."
  • Comparison. “I don’t drink as much as my boss, and he doesn’t have a problem. I knew a man who has been injecting for 30 years and nothing, he lives.

An alcoholic is able to give convincing arguments that he is not addicted, because of which his relatives often believe him, often enter into a state of co-dependence. Moreover, denials help the addict and himself to believe in this lie, stabilize his emotional state and convince himself that everything is in order. nine0004

You need to understand that the situation itself will not be resolved, because not a single disease goes away without treatment. Moreover, with each passing day, addiction will absorb a person more strongly. An integrated approach will help to find a sober life, and not just cleansing the body with a dropper. With the systematic use of mind-altering chemicals, psychophysical dependence is formed. Inaction in relation to her sometimes costs life.

Denial of addiction is a natural psychological stage. But a long stuck in the phase of ignoring the disease is detrimental to the patient and his loved ones. Addiction can grow at the speed of a wind-blown fire. And every month it is more and more difficult to snatch a person from her tenacious paws. Overcoming addiction must begin with a comprehensive discussion of the treatment and recovery process with specialists, otherwise the result can be deplorable. Only by fully overcoming denial can one move further along the path of one's own recovery. nine0004

Lecture 33. Defensive thinking Denial of addiction.

Resources for helping those suffering from alcoholism

Alcoholism and the family

Methodological materials of the center

Lecture 33. Defensive thinking Denial of addiction.


SocButtons v1. 4

Psychological defenses. Defensive thinking. Types of psychological defenses and defensive thinking: denial, minimization, repression, control, projection, comparison, fantasizing, moralization, reasoning, rationalization, substitution, ridicule. Analysis of defensive thinking. Typical addiction denial phrases. nine0004

Psychological defenses are a psychological mechanism for protecting Consciousness from painful experiences. Defenses with the help of defensive thinking distort painful information so that it is easier for the Consciousness to perceive it.

The psychological defenses of the addict protect him from the recognition of his dependence, since this recognition is extremely painful for him. Without acknowledging their addiction, a person cannot stop using and begin recovery. nine0004

Psychological defenses act unconsciously, but they can be analyzed and changed with the help of Consciousness.


Defensive thinking

What does he do?

What it sounds like

How to overcome



Complete non-recognition of problems with use

I have no problems using

Request feedback from people you trust


Downplays the problem

I don't have too many problems using


Conduct an honest analysis of consumption losses


Admits his problems but forgets about them

Oh, I forgot that I can't! Oops, I forgot to do something about recovery!

Remind yourself, plan for the day



Recognizes the problem but thinks he can handle it himself

I have everything under control! I can do it myself, without help! I can use controlled!

Conduct an honest review of loss of control cases


Attributing one's problems to others

nine0002 It's not me who is an alcoholic (drug addict), it's them! This is their problem!

Seek in other people a reflection of yourself


Comparing oneself to people whose problems are worse

I'm not as bad as he is!

Compare yourself to people who are doing better.


Unrealistic plans, fantasies.

I'll quit tomorrow!

Return to "here and now", do "only today"


Instead of looking for a solution to a problem, condemn yourself

I am a complete alcoholic (drug addict)! What I have done, I have no forgiveness (it remains only to continue to use)! nine0004

Giving up feelings of guilt and shame, taking responsibility for solving problems.


Reasoning instead of finding a solution, clever and vague formulations, long conversations, etc.

Only by joining hands together and armed with patience and impartiality can we win an unequal battle with the enemy. ..


Actions instead of words


Justifying problems, looking for other causes

I use because ... (life, family, bosses, circumstances, etc.)

Finding the root cause in your addiction



Recognizing problems, but at the same time looking for other, "more important" problems

Yes, I am addicted, and something needs to be done about it, but first you need to (earn money, improve family affairs, etc.)

Honest analysis of how continued use will affect other "more important issues". Recognition of addiction as the most important problem today.


Making problems look funny

Haha, I'm addicted!

Refusing jokes about addiction, acknowledging the "sadness" of the situation

Defensive Thinking Analysis Chart


Part of the truth

Part of a lie

Refutation of lies

Full truth

I have no problems with alcohol!

Not all problems in my life are related to alcohol

I have not had a single problem in my life caused by drinking alcohol

I drank my whole salary several times, I got into drunken fights, my girlfriend left me because of alcohol, etc.

Many problems in my life are caused by drinking alcohol


Typical phrases (thoughts) by which one can recognize the denial of illness and recovery.

My case is not as bad as the others. It is not dangerous for me to visit places where they use and (I do not develop cravings there). Non-alcoholic drinks won't hurt anything. Others have problems, not me. I have only psychological dependence, physiological yet. I do not need to write these diaries, because others recover without them. Tomorrow I will definitely start to recover. Since I do not use, I should not have emotional outbursts. If I use only once, it won't hurt me. I can date my using friends and not use. I already know enough (done, recovered) in order not to break loose. If I try, I can control. Everyone should help me in my recovery. I have more important things to do than get well. My family is more important than my sobriety. I don't have time to get well. I can just not use. Recovery is too hard. Or maybe I'm still not addicted, but just had a difficult period in my life? In order not to drink, it is enough just not to take the first glass. Now I have a gray, dull, gloomy sober life ahead of me. PAS (alcohol, drugs) helps to cope with emotional problems. PAV helps to relax. nine0092

Task for the topic "Defensive thinking"

  1. Give 10 examples of how you denied problems from using in the beginning? What did it ultimately lead to?
  2. Give three specific examples of each kind of defensive thinking.
  3. Reread the characteristic phrases of denial of illness and recovery. Choose the ones that are most suitable for you and analyze them using the Defensive Thinking Analysis Chart


Part of the truth

Part of a lie

Refutation of lies

Full truth

Sincerely, practical psychologist Denis Starkov http://www.

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Video course of lectures by psychologist Vladimir Ivanov "Alcoholism and its cure - 12 Steps approach"

Video course of lectures by psychologist Vladimir Ivanov "Codependency and its treatment"

Center for the psychological treatment of alcoholism "Sens"

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