Denial can take many forms. As an addiction treatment professional, you will find many of your clients in various stages of denial. Their inner voice says, “I don’t have a problem; I can control this. Yeah, maybe I got a DUI (or even two), but I was just in the wrong place at the wrong time. And yeah, maybe I carried it too far last Saturday and had a physical fight with my wife, but I really I think I can learn to control this. I really don’t think it’s that serious. I’m not an addict like those other people.” By the time they get to treatment, they may have problems in many different areas of their lives that have been piling up for some time. They have legal problems; they’ve lost their jobs; they’ve lost their marriages; they’ve lost their money; and they’ve lost their homes. They may have adverse psychiatric consequences due to lack of sleep and inadequate nutrition, as well as the havoc their using has wrought in their brain chemistry. They may be full of guilt and shame, and/or depressed to the point of being suicidal. Denial has a way of creating memory loss of all of the adverse consequences of active addiction. People forget about their physical dependency, loss of control, and compulsive out-of-control drug-seeking—the hallmarks of addiction. They lose sight of the experience that in the earlier stages of their using, drugs got in the way of their life, but as their using progressed, eventually life got in the way of their drugs. Even when people come into treatment, what most really want is the ability is to be able to return to drug use but be able to control it this time. As an addiction counselor, you’ll hear this expressed in a range of ways: “I don’t really think I have a problem. Sure, I wound up here because the judge said I had to go to a program, but I was just unlucky.” Or, “I really think I can control this if I just drink on weekends or just smoke pot” or “if I stick to a quarter of a gram of coke on Saturday nights, I won’t run into any problems again.” The secret desire of many people in early abstinence is to go back to “recreational” alcohol and other drug use. They want to know “why I can’t go back to using drugs like other normal people?” The reality is that typically, by the time someone gets to treatment, he or she has not used recreationally, or like a “normal” person, for a very long time. Denial can be an ongoing challenge. Even when someone admits to his or her addiction, denial can be an obstacle. It is not uncommon, particularly after a period of abstinence in early recovery, for people to convince themselves that now, with some time and separation from active addiction and having experienced some professional treatment, they can control their drug use. Maybe someone’s addiction progressed and became out of control related to his or her use of crack or crystal meth. Perhaps he or she didn’t really drink a lot and pot was never “a problem” for him or her. So, he or she figures, “I can’t use crack or meth, but I can smoke pot and drink.” The vast majority of the time, when addicted people use a mind- or mood-altering drug of abuse—whether or not that specific drug was ever a problem for them—later, if not sooner, they end up returning to active addiction. This phenomenon is known as “cross-addiction.” Cross-addiction means that an addict can become addicted to any mood-altering drug that he or she ingests. People frequently attempt to substitute some substances for others based on the misguided belief that they won’t have the same negative consequences. It is the use of any drug of abuse that reignites the flame of active addiction. Often people transition from certain drugs to others as far as their preferences, from one period in their life to another, usually starting with alcohol and pot (and, of course, cigarettes), then moving on to other substances, such as pills, cocaine, crystal meth, heroin, etc. Many are what we might refer to as “garbage can addicts,” in that they like and use anything and everything that stimulates the reward center of the brain. Interestingly, the term “junkie” came about because it used to be that addicts scrounged junk to sell to pay for their drug habit. Denial can reemerge at any time, even when people have been in recovery for years. Addicted persons can convince themselves that they can return to being cucumbers even though that is impossible, because their brains have been changed through their drug use and they have become pickles. It is only through open-minded and willing participation in treatment and an ongoing process of recovery that addicted persons keep the disease of addiction, with its potential for denial to resurface, at bay. Sometimes people may know that they are addicts but can’t admit it. I’ve seen T-shirts that say, “I don’t have a drinking problem: I drink, I get drunk, I fall down, no problem.” One of the most frustrating experiences for addiction counselors is to face people who acknowledge that they have an alcohol and/or other drug problem, but are not willing to do anything about it. Ultimately, every addicted person has to look in the mirror and say, “Okay, I’m an addict; what am I going to do about it? Am I going to ignore it, or am I going to do what is necessary to get better?” That’s the challenge. Usually, people who have this disease will attempt to control the problem on their own until they experiences so many adverse consequences and failed attempts to control their using that they can admit that such efforts just don’t work. They finally “surrender” (if they don’t get sick or die), and acknowledge their powerlessness over their addiction—the first part of the process of twelve-step recovery. The treatment outcomes for addiction are the same as those for other chronic illnesses such as diabetes, heart disease, or asthma. You will see clients who are complying with treatment and working a program of recovery, and they have positive outcomes. People who don’t take care of themselves or who don’t work with you to learn how to take care of themselves tend to have poor outcomes. People who acknowledge that they have the disease of addiction and cannot use alcohol or other drugs, who self-monitor and consistently take their “medication” in the form of treatment (including actual medication), maintain abstinence, participate in twelve-step or other mutual-aid/support group programs, and implement lifestyle changes stand a good chance of going on to lead productive, healthy lives. This blog post is an excerpt from The therapist’s Guide to Addiction Medicine – A Handbook for Addiction Counselors and Therapists – by Barry Solof, MD, FASAM; Published by Central Recovery Press (CRP).