Denial of Alcoholism as an Obstacle to Recovery

Abstract

This is a study of the effects of the mechanism of denial in the treatment of alcoholic patients. Denial is defined as an unconscious attempt to treat external reality as if it did not exist, often manifested by apparently consciously motivated prevarication. The study is based on records and follow-up data of 100 male veterans admitted to an open-ward hospital for intensive psychotherapy. Their degree of denial at admission and discharge was rated on a 5-point scale (0 to 4) and was compared to followed-up treatment results which were rated on a similar 5-point scale, 0 representing abstinence and improvement in all areas and 4 representing no change. The 65 generally unimproved patients with an average follow-up rating of 3.8 had an average denial rating of 3.2 both at admission and at discharge. The 35 generally improved patients with an average follow-up rating of 1.7 had an average denial rating of 2.7 at admission and 2.1 at discharge. Among the latter 35, the 14 most improved patients, with an average follow-up rating of 0.5, had average denial ratings of 2.7 at admission and 1.3 at discharge. The differences between the several groups compared are statistically significant. Thus, it is the capacity to decrease denial that is of significant for a favorable prognosis. Since denial is often an essential component of the syndrome of alcoholism and an opposing force to treatment, few patients are being successfully treated for alcoholism by any technique. Thus any new techniques devised to reach the bulk of alcoholics must take this defense into consideration, and to be successful, must reduce this defense.