Many people who are substance abusers, as well as their family members and friends, are in denial that a problem with alcohol and/or drugs even exists. They may pretend that there is no problem (although they intuitively know that there is), hoping that it will go away. Although it occurs commonly, this strategy does not work.

Psychiatrists use the term denial to describe a defense mechanism used by individuals or family members to avoid thinking about or dealing with the likelihood that a person has a serious problem, such as substance abuse or psychiatric illness. For example, family members may not respond to the large number of empty liquor bottles in the trash, the passing out on the couch after a night (or day) of heavy drinking, and other acts that are indicative of alcoholism. The individual, his or her spouse or partner, and others may make excuses for every one of these acts, in denial that there is a real problem. (This is also called enabling behavior.) They may say that the bottles were accumulated over several weeks' time (even though it is clear that they were consumed over several days), or that the person who passed out was tired after having a hard day.

If the individual is addicted to drugs, the family may also convince themselves that there is no problem, or, if there may be a problem, that it is only a temporary one that has developed because the addicted individual is distressed by a marital failure, a job loss, or another negative life circumstance. When the situation improves, they believe, the use of drugs will cease. They fail to see that the breakup of the marriage and firing from a job may stem directly from the individual's behavior while he or she was under the influence of drugs and/or alcohol.

Denial is a normal human reaction to many problems, but the denial of the individual and/or his family members and friends can impede the recovery of an individual from substance abuse. However, even when friends and family members accept that the individual has a substance abuse problem, this is not sufficient in itself to resolve the problem. The individual who has the problem must also accept that he or she needs help and be willing to receive such help.

Sometimes family members and friends stage an intervention, with the help of a trained professional, in an attempt to compel the addicted person to accept that he or she needs help and should enter a rehabilitation facility immediately. Sometimes interventions are effective; in other cases, the addicted person adamantly denies a problem and refuses to accept treatment.

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