Alcohol Use Disorders (139) The problem of not recognizing the problem

12 March, 2024

Dear colleagues,

Today I want to reflect on one of the main barriers in Alcohol Use Disorder (AUD): denial.

When people don't know or can't admit that they have a problem, there is no way to find a solution.

According to SAMSHA's 2019 National Survey on Drug Use and Health, 21.6 million people in the US had substance use disorders (SUD), of which only 4.3% believed they had a problem that needed to be treated. (1)

In other words, the denial of the existence of the “problem” is a major “problem” in substance use disorders.

Denial is defined as “the refusal to admit the truth or reality of something.” In psychology it is usually a defense mechanism to avoid facing a personal problem. (2)

Denial is common in people with alcohol use disorder, who tend to minimize the importance of their consumption, but it also extends to the environment of the person with AUD, whether family or friends.

There are several causes of this denial, among which the following stand out: the stigma associated with alcoholism and not being ready to stop drinking.(3)

Therefore, the first step in facing an alcohol use disorder (AUD) is to recognize and accept that alcohol has a negative impact on the person's life and, eventually, those around us.

Tools like the AUDIT and others are useful so that people with AUD can make it visible that they have a problem.

In most cases, someone who views alcohol as an important tool for managing their emotions and situations will continue to deny that they have an AUD until the problems become impossible to ignore.

Alcohol consumption can be problematic if it affects the person's health or puts life at risk due to traffic accidents or alcohol-related illnesses, or if it creates interpersonal difficulties with family and friends, if it impairs other activities such as work or study. (4)

Therefore, we should not wait for people to recognize that they have a problem with alcohol, because many times it may be too late.

Health professionals should apply available tools that make it easier for people with AUD to become aware of the problem and inform them that help is available to deal with it.

What do you think about it?

What is the situation in your country?

Kind regards,







Dr. Eduardo Bianco

Director, Addiction Training Program (ATP)



HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Masters in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Biancos research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. ebianco AT