Much of the literature on denial has focused on underlying mechanisms that contribute to false negative reports regarding SUDs. Possible mechanisms include deliberate and conscious lies to avoid negative views from others or consequences of the behaviors (Fewell and Bissell, 1978) and false negative reports from cognitive difficulties in correctly appraising the dangers of the substance use (Rinn et al., 2002; Tarter et al., 1984). Other theories reflect psychodynamic defense mechanisms where persons facing substance-related psychological stressors subconsciously “defend” themselves by denying that the substance problem or adverse event occurred (George, 1990; Khantzian, 2018, Rinn et al., 2002). It is likely that multiple factors contribute simultaneously to denial (Sher and Eply, 2004; Wooley et al., 2012), and the literature suggests that the underlying mechanisms might differ with different drugs (e.g., denial to avoid negative attitudes toward the user might be more prominent for intravenous heroin than for alcohol) and for different situations (Pickard, 2016; Sher and Eply, 2004).
