Serving nearby areas by Palm Beach and West Palm Beach, Florida



According to the 2018 National Survey on Drug Use and Health, an estimated 21.2 million people (aged 12 or older) needed substance use treatment. Only about 3.7 million people received any kind of treatment (including those receiving care in jail or prison), while a meager 2.4 million received specialty substance use treatment.

What about those people that needed specialty substance use treatment but didn’t receive any? Well, according to the same survey, a staggering 95% “did not feel they needed treatment.” The remaining 5% either felt they needed treatment but didn’t try to find it, or felt they needed treatment and made an effort but did not receive treatment. In other words, roughly 17.5 million people who are addicted to drugs or alcohol don’t believe they need help for it—despite any fallout, loss, heartache, or consequences.

            So, what drives virtually this entire group—numbering in the tens of millions—of chronically sick people to eschew support, refuse treatment, and/or avoid any kind of help?

            Denial. “A refusal to admit the truth of a statement” or more pointedly here, “a defense mechanism in which confrontation with a personal problem or with reality is avoided by denying the existence of the problem or reality.” Alcoholics Anonymous suggests that this type of denial is “insanity or outright delusion.” And although the degree of self-deception or rationalizing may vary just as the severity of one’s substance use disorder, some form of denial will almost always take a central role as the primary roadblock on the road to recovery.

            To illustrate, the following first-person account describes the mental gymnastics and rationalizing that can be motivated by denial:

I drank 2 1∕2 weeks after an esophageal hemorrhage. Couldn’t bring that into

my mind with sufficient force because I had already convinced myself that scar

tissue is stronger than normal tissue (they cauterized the wound). Even brought

photos home they took with the endoscope to remind myself. I now had a super

esophagus and was good to go, so to speak.


(Pickard, H.; Denial in Addiction). Notably, the speaker reported that the above internal dialogue took place after his doctor told him that if he were to continue to drink, he would die.

            Does this mean that persons suffering from substance use disorder just need a reality check? Presumably one can choose to accept the truth, so is encouraging persons to seek treatment as simple as preventing them from denying their condition? Not exactly.

            According to several research studies, understanding why relapse in the face of dire consequences will not always compel abstinence begins with acknowledging addiction as a neurobiological disease of compulsion. The explanation is that addiction “hijacks” the brain so that addicts lose all control over their consumption and cannot help taking drugs, despite the consequences and against their best interests. Thus, substance use disorder research and prevention should focus not only on the evidence that drug/alcohol consumption involves choice but also the cognitive distortions in addiction that impact that choice.


At Romano Law Group, Rainer Boggiano is focused on representing plaintiffs in catastrophic injury matters, including wrongful death, negligence, medical malpractice, and products liability litigation.

Rainer earned his Juris Doctor from the University of Florida Levin College of Law in Gainesville, Florida and his Bachelor of Business Administration in Economics from Florida Atlantic University in Boca Raton, Florida.

While attending law school, Rainer served as a judicial extern at Florida’s Fourth District Court of Appeal and a legal intern for ADT Security Services at its corporate headquarters in Boca Raton. He graduated with multiple Dean’s List honors and was a Pro Bono Award recipient in recognition for completing 150+ hours of community service. Currently, he is assisting with the Pro Bono work on behalf of the Florida Association of Recovery Residences.

Rainer is active in several community organizations, having served as a volunteer for the 15th Judicial Circuit’s Guardian ad Litem Program, a tutor at the Mandel Public Library’s homework center, and a mentor for several local non-profit organizations.



Susan Ramsey is both an attorney and an RN. Ms. Ramsey’s professional experience began as a Registered Nurse in the Intensive Care Unit at Yale New Haven Hospital. While pursuing her Bachelor’s Degree, she was a counselor with the New Haven Rape Crisis Program. During her time with the Program, Ms. Ramsey counseled sexual assault survivors and performed seminars for local police departments, universities, and high schools.

During her time working as a registered nurse, Ms. Ramsey decided to attend law school. Ms. Ramsey graduated from CUNY Law School, and has practiced law in several different State and Federal Courts.  She is a Florida Heath Care Risk Manager and a member of the Palm Beach County Sober Home Task Force.  Susan is Pro Bono Counsel for the Florida Association of Recovery Residences.

Ms. Ramsey actively litigates cases involving catastrophic injuries and wrongful death on behalf of survivors, cases include injuries suffered by victims of professional product liability and medical negligence.