These levels of denial may be observed by family, healthcare workers and friends in the alcoholic.
Level A: “No Problem”
The person at this level is denying any emotional or familial problems. They may be in treatment as a requirement of probation etc. There is no commitment to change because their view is that nothing is wrong. This person may be defensive and confused by the focus on alcohol and would not speak of alcohol of their own accord. If asked, they say that alcohol is easily controlled, may be fun, and is definitely not affecting the family. They may report choosing to refrain from drinking (or quitting) for various reasons. In either case, the person has nothing to talk about; and therefore, any helping person usually feels as if he has nothing to treat.
Level B: “A Problem”
The person at this level will still actively deny that alcohol is a problem; may spontaneously report having a problem such as nerves, depression, kids, health, money etc.; may feel misunderstood if their “problem” is not attended to and may feel maligned if alcoholism is the focus. On the other hand, the person may express some concern about the possibility that drinking will become an issue, and there is an indication of a willingness to cooperate in the treatment process.
Level C: “Alcohol is a Problem”
The person at this level agrees that alcohol contributes to life’s difficulties; however, there is a conviction that these difficulties are controllable. Drinking is seen as a reaction to and a way of coping with life’s problems – self medication. They have a feeling that gaining control over these difficulties will control the drinking. There is no belief or genuine understanding that alcoholism is a primary problem, a disease, autonomous and progressive. The loss of control over drinking, if present, is denied too. This person is still hanging onto the idea that an alcoholic drinks more than he/she does. This person becomes defensive if anyone focuses on alcoholism.
Level D: “Sobriety may help, but I can control it”
This person accepts the idea of having a major problem with alcohol and may even call himself or herself an alcoholic. However, this person denies being out of control and thus continues to try and “control” the drinking. This may be expressed in attempts (successful or not) to limit the drinking or in behaviour that denies the wish to drink, ie, sipping drinks and asking for support and approval (from the therapist or partner) for the control. There may be attempts to blame particular beverages such as “it was the rum” or “it only happens when I drink wine”. This person may also report being an alcoholic in the past, but not now. There is some recognition that things were out of control. The erratic nature of the disease is perplexing and confusing, but there is no urgency to stop.
Level E: “Sobriety will help”
This person recognises that the drinking is out of control and that their life is out of control due to drinking. There is conscious anxiety, guilt, and shame about the loss of control, and the focus of effects can be either out-of-control drinking or out-of-control life. This person may still be drinking or recently sober and may be concerned about losing family or job, or going to jail, or going insane. The focus for this person is the overwhelming realisation of loss of control rather than what to do about it, since there is the belief that it is too much to do alone, by themselves. This person turns to the therapist or friends seeking control. This person is committed to change. Alcoholism is seen as an illness, but the numerous implications are not yet appreciated.
Level F: “Sobriety is easy”
There is commitment to sobriety, but the anxiety of the previous level is absent. Some people at this level feel great and the phenomenon has been described as the ‘honeymoon period’ of recovery. However, some people may feel miserable. The salient feature is the belief that they can do it all themselves. Recovery is seen as just not drinking, minimising the degree to which life has become entwined with alcohol. Consequently, this person minimises the number of changes, which must occur to stay sober and to begin to rebuild their life.
Level G: “Sobriety is difficult”
The person at this level again experiences anxiety, but this time the anxiety is about reconstructing their whole life and making amends, like saving a marriage. This person realises their own role in carrying this out and seeks reassurance and support for the struggle, rather than asking the therapist to do it for them. This person is not yet interested in exploring the past or present for deeper psychological meaning. The focus is often on exercising control, problem solving, social skills, etc.
Level H: “Life is difficult”
This person has gained confidence that life can be controlled without alcohol and now appreciates some of the subtle dilemmas of existence and seeks an age appropriate maturity. This person often experiences neurotic patterns and needs to explore them. Self-exploration begins here spontaneously because the alcoholic can control effects enough to talk about their behaviour and thoughts, looking at fear, shame, guilt, anger etc. This person is definitely connected to their self-image as an alcoholic and knows how easy it would be to fall back to drinking but is not threatened by this knowledge.
Level I: “Life is good”
This person has progressed through a program of recovery, such as Alcoholics Anonymous, and maintains a level of functioning, which attracts other people. Throughout the recovery process they have evolved spiritual boundaries, a close relationship with a guide or sponsor and continue to share their experiences with others. They have re-established community work, careers, relationships and family ties. Pleasure is experienced in nature and peoples personalities. Life is normal with its ups and downs being tolerated and handled in appropriate ways. Sober life is good.
Goldsmith RJ & Green BL. (1988) A Rating Scale for Alcoholic Denial. Journal of Nervous and Mental Disease. V176, No10; 614-20.
One method of helping an alcoholic see reality is BriefTSF, a manual of helping.