Denial in addiction: toward an integrated stage and process model--qualitative findings.

Focus groups were conducted at five chemical dependency treatment facilities assessing residents' (N = 65) conceptualizations of denial and the role it may have played in the pathogenesis and progression of their substance use disorders. Two of the authors read verbatim transcripts of the focus group proceedings and independently developed models of denial based on those data. The first reader identified a core set of interpersonal and attributional processes that appeared to explain why many participants did not perceive their substance abuse and associated problems as clearly aberrant and/or chose not to self-identify as alcohol or other drug dependent until late in the course of their chemical dependency. The second reader identified five stages that clients appeared to pass through as they progressed from no awareness of their substance use disorder to full awareness. A second set of readers then independently developed an integrated stage and process model of denial that incorporated elements of the models identified earlier. Though obviously exploratory in nature, these findings suggest that denial is a far more complex and dynamic set of intra- and interpersonal processes than is generally recognized.