One finding of a recent survey of long-term opioid users and those who live with them: There’s a serious gap in perception when it comes to the harm caused by drug use. While users may openly acknowledge addiction, they’re likely to resist change, on the grounds that things just aren’t that bad. That’s in stark contrast to others in close proximity, who seem far more aware of adverse consequences.

Not a surprise, is it? Clinicians offer different explanations.

Denial — This term, borrowed from psychoanalysis, describes a defense against anxiety. It’s unconscious, meaning the addict is not aware of it.

Family pressure – The more others push, the greater the resistance by the user. That includes refusing to acknowledge the problems your drug use creates.

Something neurological — Impaired cognition, perhaps diminished self-awareness. The addicted brain can’t accurately evaluate its own status.

Stigma— A certain amount of shame is attached to substance disorders. Acknowledging the need for help may simply cost too much in terms of lost self-esteem.

Any and all of the above may play a role. But what about the perceptions of those who live with the addict? Are those accurate and trustworthy, or also subject to some distortion? Possible factors:

Anxiety — Family members fear addiction, for good reason. But that fear, like any strong negative emotion, can affect judgment.

Poor communication – Communication breaks down fairly quickly, which contributes to misinterpretation and misunderstanding.

Confirmation bias –  As Paul Simon put it: “a man hears what he wants to hear, and disregards the rest.”

Conflict — As with anxiety, resentment and simmering anger can also affect our perception of a complex situation.

There’s no simple way to untangle this. It does help to get outside perspectives from knowledgeable people. Then triangulate their advice and opinions to arrive at something resembling an objective assessment of your situation. Look for areas where there’s agreement before deciding on your own course of action. Once you do, run it by them for helpful feedback.

It’s not magic, either. But it helps.


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