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“Applying the Principles of Deception Detection to an Addiction Treatment Setting”

Crystal Hewitt-Gill

Spring 2014

Readings in Psychology

Dr. Douglas Peters

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Deception is an integral component of addiction. Whether the root problem is a

substance (e.g. alcohol) or a behavior (e.g., shopping), an addict deceives themselves and others

around them as their use increases, and may go to extreme lengths in order to conceal the

problem from the people around them. In the longer term, this may result in a kind of

compulsive dishonesty, wherein the addict automatically lies in circumstances that do not require

any kind of prevarication. Active addiction also inhibits insight, which results in the person

engaging in self-deceptive practices to rationalize their continued use despite evidence of

growing problems. (While there is considerable overlap between drug addiction and criminal

activity, and while drug addiction can certainly be regarded as a criminal behavior unto itself, for

the purposes of this paper I would like to distinguish between habitual illicit drug use and other

kinds of criminal activity. I will refer to drug addicts as clients or patients, and approach

deception detection from a clinical rather than a criminal justice standpoint, in keeping with the

DSM-V, ICD-10, and ASAM definitions of substance addiction as a medical disorder.)

In addiction treatment programs, and in the 12-step philosophy on which Alcoholics

Anonymous and Narcotics Anonymous are based, there is a heavy emphasis on the importance

of honesty. Deceptive and rationalizing behaviors are often “called out” in order to address the

underlying addictive thinking. The 4th step in a traditional 12-step program is defined as

“Making a searching and fearless moral inventory” of oneself; that is, the recovering addict is

expected to examine every flaw and self-defeating behavior without deflection or defensiveness.

The logic behind this step is that active addiction requires a great deal of dishonesty, and so to

truly break free from one’s addictions, one must become rigorously honest and self-aware. The

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popular slogan, “Relapse begins with a lie,” refers to the tendency addicts have to engage in self-

deceit when they are in vulnerable situations to use their drug of choice.

In a clinical environment, counselors are often trained to regard client dishonesty as a

common and expected occurrence. However, because the client is regarded as a patient and not a

criminal, there are very few empirically testable means employed to determine whether or not

the patient is actually lying. Although many clients are mandated, the setting is not a forensic

one, and so counselors and behavioral health professionals do not use the same tools to detect

deception (e.g. polygraphs). The most relied-upon indication of client deception is a clinician’s

intuition, which is often fundamentally biased and may miss critical opportunities to identify

clients who are most at risk for relapse. Although clinicians are intended to function as objective

observers, they may come down on the side that addicts are fundamentally dishonest and that

most of what they say, on the surface, can be disregarded as storytelling. (As the book

“Detecting Lies and Deceit” indicated, even highly trained counselor and court workers

consistently suffer from an overconfidence bias, also called the relational truth-bias heuristic.

We believe, to our own detriment, that a personal relationship with the client gives us greater

insight into their thought processes, and that any deviation from their “usual” temperament

indicates a lie or significant change. As such, there is a high risk that we may be overly focused

on relatively minor, transient changes in a client’s demeanor, and therefore miss the legitimate

signs of an impending relapse). It is also counterproductive to adopt an accusatory stance within

a drug-treatment program, as research has demonstrated that harsh tactics are generally not

successful with an addicted population (Petrosino et. al., 2002). The research behind addiction

actually indicates that this approach is counterproductive for our purposes and does not result in

long-term recovery.

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Current means to detect lying – most often manifesting in the resumed use of the drug of

choice – are basic and may not be particularly effective. At present, drug testing is used as part of

a standard protocol in most addiction treatment centers. However, there are a number of

problems with using standard drug testing as a monitoring tool. Most narcotics (including all

opiates and both the powder and rock forms of cocaine) are water-soluble, which means that a

single use is eliminated from the body within a 72-hour timeframe. The use has to have occurred

within the past 2-3 days to be detected. This is common knowledge to the point that it is

colloquially referred to as the “72-hour rule.” (At present, the only commonly used lipid-soluble

drug is marijuana, which accounts for a disproportionate percentage of positive drug screens.)

While blood and hair analysis can be used to detect use over a longer time frame, these tests are

often not available in drug treatment clinics, and they are much more expensive than a standard

urinalysis drug test.

The use of alcohol also presents unique problems; while a 72-hour test is available to

detect the presence of ethanol metabolites, the test is cost-prohibitive and again, there is a limited

timeframe. A patient could drink heavily on a Friday afternoon and test “clean” on a Monday

morning. The Breathalyzer is most often used to test for alcohol use, but this further reduces the

available timeframe from 12-24 hours. There is also some margin of error in drug tests

themselves, which can allow a client the opportunity to simply deny any use and fault lab error.

Generally speaking, the use of drug tests is often only effective when the patient has already

been forthcoming concerning what substances they have used and when. Given the nature of

addiction, this is unlikely to happen.

As the readings have demonstrated, there is no uniform test for deceit, and applying a

single standard may be counterproductive. Even if such a common standard existed, the addicted

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population would still present some significant and unique challenges. There are numerous

considerations when looking for signs of deceit in an addict, not all of which may be related to

conscious untruthfulness. Below, I will outline some of the problems that may arise in deception

detection among an addicted population, and why they are significant.

To begin with, many new patients may be suffering from short- or long-term cognitive

impairment related to their substance abuse. Some addicts have sustained irreversible brain

damage as a result of their use. People who use inhalants or certain types of hallucinogens (e.g.

MDMA or “Molly”), late-stage alcoholics, or patients who have experienced an overdose

(particularly if there was inadequate oxygen supply to the brain) are at a sharply increased risk of

long-term memory loss and chronic confusion. If a client experienced chronic blackouts or lost

consciousness as a result of their use, neurological recovery can take years. (While the research

about the extent to which the brain can recover from addiction is somewhat contradictory, there

is a general consensus that most major neurological recovery will occur in the first two years of

sobriety. There is a popular, but misinformed perception that drug and alcohol use “kills” brain

cells – in fact, it only inhibits neural growth. Because of this, complete or near-complete

recovery may be possible, but it will take place over the course of many years. Most clients come

into treatment very early on in the recovery phase, possibly still in an acute detoxification stage.

As a result, we may not be able to see either their full cognitive capabilities or authentic

temperament at first.)

Post-acute withdrawal syndrome (PAWS) can also cause a number of physical and

emotional symptoms that may be incorrectly interpreted as signs of lying. PAWS is typically

seen in a client anywhere from a few weeks to six months following acute detoxification. This

syndrome, thought to be caused by alterations in brain chemistry and longer-term neurological

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recovery, produces a host of reactions in the recovering addict or alcoholic. Mood swings,

lethargy, anhedonia, anxiety symptoms, sleep disruptions, hyperarousal, memory and cognitive

impairment are all noted during this period of protected withdrawal. The person may have

problems maintaining concentration or speaking in a coherent and understandable fashion.

There are often observable physical symptoms to accompany the disorder, and it may be useful

for counselor to be able to identify them. For example, it is common that many long-term

alcoholics, even after acute detoxification, will experience hand tremors and nystagmus (a rapid

and involuntary darting motion of the eyes), which signifies nerve and brain damage. To an

untrained observer, however, they may look like signs of nervousness or shiftiness.

Late-stage addicts often confabulate, which is not precisely the same as lying but may be

incorrectly categorized as such. Confabulation is one of six symptoms attributable to Korsakoff

syndrome, a degenerative neurocognitive disorder that occurs in long-term alcoholics. The other

symptoms include both anterograde and retrograde amnesia, flat affect, and a general lack of

insight. Due to significant memory deficits induced by a severe thiamine deficiency, the

alcoholic subconsciously or unconsciously “fills in” their memory gaps by creating stories.

These confabulations may be highly detailed and strongly suggest deceit; however, their goal is

not to mislead. Confabulation puts a client more on par with a psychotic patient than a chronic

liar. The person genuinely believes what they are saying, because their brains have essentially

constructed false memories. (Confabulation is, in fact, functionally similar to the phenomenon

of false memory in forensic settings.)

Lastly, addicts in early recovery may be depressed or uncharacteristically anxious. (This

is especially true if a client is facing serious repercussions should they fail to successfully

complete drug treatment, such as a prison sentence). Statistically, addicted populations

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experience higher levels of mental illness than the general population, which can also impact

presentation, cognition, affect and speech patterns. A client with an anxiety disorder, for

example, may appear uncomfortable regardless of the situation, or a client experiencing

posttraumatic symptoms can often present signs of discomfort and disengagement. (While there

are clients in drug treatment who also suffer from antisocial personality disorder, the type of

lying a sociopathic individual does is fundamentally different from the type of lying an addicted

individual does, both in terms of content and purpose. Addicts don’t generally deceive for the

pleasure involved, unless they also harbor some antisocial tendencies. Here, it is important to

make this distinction. As stated earlier, our goal in detecting lying is different in a treatment

rather than forensic setting, and so to an extent we are less focused on secondary behavioral

disorders. Client safety and recovery are always considered to be the primary objectives.) Taking

all of this into account, there are a number of “false positives” that clinicians need to be aware of

before assuming that the motivation behind a patient’s demeanor is always intended to hide their

drug use.

What should we look for, as counselors, to determine whether a lie has taken place?

Physiological arousal, as the reading has demonstrated, can indicate a number of emotional states

(including defensiveness) that are not necessarily a sign of lying. We also have to consider the

idea that an addict in the early stages of sobriety may become more indignant if falsely accused

of lying than a person who actually is lying. Regaining credibility and the trust of other people

can be a difficult and demeaning process for a person in recovery, and they can feel irrationally

offended when someone incorrectly accuses them of relapse.

The best approach to determine dishonesty, and the one that is both analytically and

clinically appropriate, is to look at the congruence between verbal and non-verbal statements.

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Does the body language match to the words being expressed? Are they hunched, self-protective,

or hostile? Do they make verbal expressions of confidence and security with averted eyes and

slumped shoulders? In “Telling Lies”, the text also discusses “micro expressions”; that is, split-

second involuntary facial expressions that belie the client’s real emotional state. While we may

not “see” these expressions at first glance, clinicians can be trained to detect them while

conducting individual sessions with a client. Paul Ekman, the author of “Telling Lies”, also

defined “Squelched Expressions” and “Automatic Expressions” as indicators of this type of

incongruence. An asymmetrical expression or one that is displayed for an unusually long or

short period of time are also shown to be signs of insincerity. While people are able to control

their words, they are much less able to fully control their reflexive expressions. This is also a

much more objective approach to deception detection, limits the impact of our own biases, and

can be done in a non-invasive way.

How do we determine the overall likelihood that a person will lie? If a client is mandated

by a court, then they have a more pressing reason to lie. We may find the adaptational model of

malingering, when applied to detection deception in general, to be the most helpful and

applicable. The adaptational model outlines three circumstances under which a person may feign

illness (or, for our purposes, lie): when the stakes are high (that is, if failure to complete will

result in revocation of a probation or parole term); when there is no available alternative

(treatment is not voluntary); and when there is an adversarial relationship between parties (i.e., a

client and the courts). If this is the last option before prison, a person is inclined to feel that they

have more to lose. There can also be mistrust of the clinician, whom the clients may feel are “on

the judge’s side”. By this logic, a client who comes to treatment voluntarily may be somewhat

more forthcoming about their use. Still, the reasons for lying are myriad.

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However, it is short sighted to simply determine that a lie has happened. In a treatment

setting, this is akin to collecting data and then not analyzing its contents. We can readily accept

that notion that addicts lie; the more crucial question, and the one that will essentially guide any

future treatment plan, is what motivates the lie. This seems like a self-evident question at first

glance. On a whole, the motivation to lie comes back to the same desire: avoiding a negative

consequence. One does not need to possess any pathology to engage in deceptive practices from

time to time. Even children innately understand the motive to stay out of trouble through

lying. By itself, it does not tell us much about the person. People in active periods of drug use do

not want to stop using their substance or substances of choice, but why? In other words, what is

driving the lie about their use? Beyond the obvious addictiveness of their preferred drug, what

causes a person to choose drugs over quality of life? There are two general explanations for

explain an addict’s reluctance to address their drug problem. The first is that an addict wants to

keep using; the second is that they feel unable or unwilling to stop.

Initially, wanting to keep using and not wanting to stop seem to be identical principles,

but where a person lands on this spectrum determines a great deal about how progressed they are

in their addiction, and the underlying reasons for their lying. I will discuss the distinction at

greater length directly below. This will also bring us into four defined categories I have loosely

modelled on the five Stages of Changes and the Jellinek curve of addiction, which will help us

further clarify the particular motivations for dishonesty in a client.

Contrary to what many people believe, addiction is not a machine that runs of itself - that

is, despite a drug's ability to hijack and override many self-protective reflexes fundamental to

human nature (relationships, safety, shelter, sustenance), there is still a cognitive process

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involved. These cognitions may appear bewildering to people who are not familiar with the

addictive process. A person becomes more and more preoccupied with obtaining and consuming

their drug of choice, which usually requires money (or other resources). The process is

survivalist, even when the methods are sophisticated. Regardless of whether their drug of choice

is expensive, makes them feel ill during use or afterwards, and strains relationships with friends

and family, an addict is singular in their determination. Addiction is, at its core, about an

untenable cognitive dissonance: the person seeks their drug of choice to escape pain and

emotional discomfort, simultaneously aware and unaware of the effects their continued drug use

is having on their life, thus creating more pain to numb with drugs and alcohol. To fully

understand the nature and trajectory of addiction, we have to first comprehend the human need to

compartmentalize distressing information, and learn how to circumvent rather than attack that

impulse. We should also understand that few psychological processes are linear and

automatically identifiable, and that the four categorizations are intended to provide a guideline

rather than an immediate diagnosis.

The desire to continue using generally occurs in early to mid-use. If a client comes into

treatment at this stage, it is usually (though not always) at the behest of a parent or romantic

partner. The user may have experienced some withdrawal symptoms if use was abruptly

discontinued, but has not experienced any serious consequences of their use at this stage. Using

drugs or drinking alcohol is still highly pleasurable, and there is a consistent money source (a

job, family, public assistance, or friends) to fund the habit. There may be brief, transient anxiety

concerning their usage, usually over a practical concern (e.g., too much money is being spent on

the drug, or recovering from its after-effects). However, we have to fully consider the idea that

the client may minimize their use because they genuinely do not believe it to be that serious. This

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is particularly true of young users, who are more inclined to feel invulnerable to illness and

death.

At this point, a lie will most likely take the form of denial and minimization. They will

usually only lie about details surrounding their use, rather than the use itself. There is minimal

shame and outwardly-directed hostility at this stage. The client may also deny any negative

feelings or concerns surrounding their use. In the Stages of Change, precontemplation is defined

as the phase when a person is wholly unaware of the problems their use has caused in their

life. This implies that addiction is a state of pre-consciousness, with recovery as the state of

awakening. This can often be true of people whose use is beginning to cross over from

recreational to compulsive. (This is also often true of prescription drug addicts, who believe that

the legitimacy of their drug choice precludes it from being a “real” addiction.) They may still

regard the use as social or casual, and believe that they are not fully addicted. An open-door,

harm reduction approach may be most appropriate at this stage.

The second stage can be termed the Defiant motivation to lie - this is characterized by a

defensiveness and deflection about one’s use. In these types of lies, a client may attempt to

change the subject or will deny riskier behaviors (e.g. use of needles, drunk driving, having

unsafe sex). They may be more likely to point to the drug use of other people around them as

proof that theirs is relatively minor. This is at a critical stage in the addictive process – the person

is becoming aware that other people view their use as problematic, even if they do not think so

themselves. This is naturally likely to arouse a client’s defenses. A client may begin to make

promises about cutting down or quitting eventually. It should be noted that this is a deeply

uncomfortable point for the burgeoning addict. They are not ready to quit at this point (and often

lack the necessary tools with which to do so), but they are beginning to experience more serious

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consequences to their use. The defiant motivation generally occurs during the contemplation

stage of change: the person is starting to doubt their control over the situation but is uneasy at the

prospect of stopping. However, they do not want to be “told what to do” – i.e., forced or “guilt-

tripped” into stopping. Rationalization and justification are very common at this point: the drug

or alcohol addicted client will state that they “need it to have fun”, “deserve it,” and use it to

mitigate stress and frustration. One of the more interesting aspects of this stage is the degree of

projection and transference that may occur: a client will fault the counselor for essentially not

facilitating the process of recovery for them. They want a clinician to make the process easier or

appealing, and when it is not, they can return to their use without feeling wholly responsible. At

this stage, Motivational Interviewing may be the most helpful approach. It is imperative to not

try to overtake the resistance with dominating or shaming behaviors: the client is already on alert

for any sense of judgment from other people.

The Fear motivation to lie often occurs in the later stage of use: there is a genuine anxiety

that they are too physically or psychologically addicted to quit, or they don’t know how to cope

without their drug of choice. This is most frequently seen in people who started to use drugs or

drink early on in life (usually in their teenage years). Their habit is deeply ingrained at this

stage, and efforts to stop have been generally brief and unremarkable. They may report that

periods of sobriety were happy or productive, and often cannot pinpoint an exact reason that they

have relapsed. An addict in this motivation stage does not yet fully comprehend how drug use is

the central focus of their life, but can identify ways that their use has negatively affected their

life.

In one of addiction's more perverse ironies, an addict may continue to use a drug or drink

just to forestall withdrawal symptoms. This impulse may be strongest in alcoholic and opiate

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addicted patients. Sobriety, even brief sobriety, is frightening and unpleasant. There are often

health problems (e.g. hepatitis) stemming from or secondary to their use. The person may be

afraid that they are going to die or become very sick, either from overdose or withdrawal. For

people who have already experienced strong physical and psychological symptoms of

withdrawal, avoiding this (however inevitable) consequence can be the impetus behind their use.

Lies at this stage of use may be broader; rather than promises to cut down, the person may deny

use altogether (regardless of how clear it may be that they are still using). They are also more

likely to dismiss any prior efforts at recovery and to reject the idea of attaining sobriety. Clients

who are motivated to lie and self-deceive out of fear often experience large amounts of shame

and feelings of worthlessness. It is important for the clinician to recognize that, however much

the person appears to be attacking drug treatment, they are really expressing self-doubt. They

are already aware that recovery is not “easy”, but to rationalize their continued use, they have to

find fault with the methods behind drug treatment. Here, a holistic approach can be used. The

first step is to ensure that the client has been safely detoxified from their drug of choice. This

may necessitate an inpatient stay, and medication management (e.g. Campral or Suboxone) is a

valuable tool for people who have a strong aversion to withdrawal symptoms. Stabilization is the

first priority for a patient in the later stages.

The Hopeless motivation to lie occurs almost exclusively in late-stage use. This can also

be termed The shame-based lie. The person has already experienced serious consequences to

their use – illness and hospitalizations, jail or prison time, the loss of a relationship or custody of

their children. They are often mandated to treatment, and feel powerless and resentful because of

it. Powerlessness is the dominant mentality and state at this point. The client (this seems

especially true of people who have been incarcerated multiple times) has “given up” trying to

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restore their life and maintain sobriety. Often times, we will see a person with a criminal record

have the most difficulty integrating into society. Unfortunately, this often keeps the addict on

the margins. Here, we want to make sure we are not applying our own standards of “having a

good life” to the client’s goals.

This type of client may appear more streetwise than other addicts. They may well have

resorted to criminality to fund their habit and therefore may be more inclined to con and

manipulate the clinicians. Again, it is vital that the clinician does not personalize these attempts

to control and direct the situation. This if often the most difficult type of client to treat, because

they may believe that their primary identity is that of an addict.

By using these general guidelines, we can better identify a client’s needs and the intensity

and length of their addiction. This is not to suggest that any stage is more or less “serious”, nor

should it be regarded as such by the clinician. This is intended as a way of establishing how

progressed the patient is, and to modify our treatment efforts accordingly. The recent adoption of

motivational, evidence-based, trauma-informed, and harm reduction techniques in many

addiction treatment centers shows the need to modernize addiction treatment as we begin to

better understand the nature of addiction itself. If we can determine the root source of a client’s

deception, that is much more useful to us than to adopt the dismissive attitude that “all addicts

lie”. To be fully effective as clinicians, we have to first understand the client’s experience with

treatment. In the end, deception detection in addiction treatment is not designed to confront a

person with their own maladaptive behavior. Effective deception detection will function as both

a way to identify client vulnerabilities and direct the treatment process itself.

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Works Cited:

Vrij, A. (2000). Detecting lies and deceit: The psychology of lying and the implications for

professional practice. West Sussex, England: John Wiley & Sons Ltd.

Elkman, P. (2001). Telling lies: Clues to deceit in the marketplace, politics, and marriage.

New York, New York: W.W. Norton & Company, Inc.

Salter, A. (2003). Predators: Pedophiles, rapists, & other sex offenders: Who they are, how

they operate, and how we can protect ourselves and our children. New York, New York:

Basic Books.

(2004). The detection of deception in forensic contexts. United Kingdom: Cambridge

University Press.

Petrosino, A., Turpin-Petrosino, C., and Buehler, J. "Scared Straight" and other juvenile

awareness programs for preventing juvenile delinquency. Editorial Group:

DOI: 10.1002/14651858.CD002796 Published Online: 22 APR 2002

Levy, N. (2003). Self-deception and responsibility for addiction. New York, New York:

The Guilford Press. DOI: 10.1111/1468-5930.00242