One of the most stressful and emotionally painful things a person can go through is the loss of a loved one. According to the Holmes and Rahe Stress Scale, a ranking of the events most likely to cause stress-related illness, the death of a spouse is the most stressful thing a person can experience, and the death of a close family member is ranked fifth. There are also different types of loss, such as the loss of a job, loss of a friend (from circumstances other than death), loss of one’s home, loss of health, loss of trust in a close individual, and so on.
Whatever the cause, everyone experiences some form of loss and grief in their lifetime.
According to the National Adolescent Health Information Center, 90 percent of high school students surveyed said they had gone through the loss of a loved one.
The grief that comes with loss is universally distressing, but each person experiences it differently. Some people may fall into a deep depression and have trouble doing anything. Others may go numb and be unable to feel their emotions. Some individuals may seek change or an experience that makes them feel alive. A significant number of people will also turn to substance abuse to help them deal with the pain, and some of those individuals will become addicted.
The Stages of Grief
There is no right way to grieve. There is no “normal” in the process. Some people will get through grief quickly, while others may grieve for years. In many circumstances, grief will come and go, and just when you thought you were done grieving, more pain comes along. The only constant in grief is that it’s necessary to allow the grieving process to carry out as it needs to. You can’t rush through grief, and you can’t force it to stop.
Many people refer to a list of stages that individuals commonly go through when they’re grieving. The Five Stages of Grief list was created by Elisabeth Kübler-Ross in 1969 and based on the emotions that terminally ill patients go through after learning that they’re going to die. The experiences on the list are common in grieving persons, especially if one of their loved ones has been diagnosed with a terminal illness. The five stages are denial, anger, bargaining, depression, and acceptance.
A grieving individual may experience all, some, or none of these emotions. It can be helpful to know that any of these experiences is normal, but you do not have to go through these stages in order to heal or be “done” with grieving. Kübler-Ross herself said that she was never attempting to give the impression that there is one way to grieve or even a typical way to grieve. A study published in 2007 even found that most people reach some level of acceptance very soon after the death of a loved one.
Experts have come up with a more comprehensive list of experiences and feelings that occur in people who have just experienced loss. These include:
- Shock and disbelief: It’s common to have a hard time accepting what happened or remembering that a loved one is gone. People often find that they expect a deceased loved one to appear in situations they would normally be.
- Fear: Any kind of loss can make people feel vulnerable and unsafe. They may have to face the reality of death, or, in cases of a loss of financial stability or health, fear that they will never be secure again.
- Sadness: This is an extremely common and expected emotion connected to loss, but it can take many forms. Loneliness, a feeling of emptiness, and despair can be a part of that sadness, and it can progress to depression.
- Anger: Don’t be surprised if you feel angry at the person who died, at others for acting in ways you don’t expect, at your higher power, or at doctors, even if they did the best they could. Grief and anger are not always rational, and you don’t have to be rational while grieving.
- Guilt: Many people experience feelings of guilt over how they’re feeling or the things they wish they’d done before the loss occurred. They may even feel responsible for someone’s death in some way, even if they did nothing to contribute to it.
- Sickness: Grief and intense emotion of any kind can often manifest in physical symptoms. This includes physical pain, nausea and loss of appetite, insomnia and fatigue, and a lowered immune system.
Grief and Addiction
When grief is intense or lasts for an extended period of time, it can take a toll on the psyche. People who experience despair or whose lives are complicated by the loss are especially vulnerable to mental health issues including addiction disorders. According to reports, people addicted to drugs are around twice as likely as those without addiction to experience mood disorders, and vice versa.
When nothing else seems to help, people may turn to substances like alcohol and drugs to dull the pain or experience some level of happiness. When the substance produces the desired effect, the behavior is reinforced, and that person is more likely to drink or take drugs again. The longer and heavier the substance use, the more likely that dependence and addiction will develop.
Addiction is classified as a mental illness that can affect anyone, though some people are more predisposed to addiction than others. There are two main types of addiction: physical and psychological. Psychological addiction, often referred to as dependence, is classified as the emotional desire or need for a substance. People who use a substance for an extended period of time may find that they’re distressed when they don’t have access to it and have trouble experiencing pleasure without it. Physical addiction happens when the body changes to accommodate the heavy, ongoing use of a substance and a person experiences physical withdrawal symptoms when the use stops. Not everyone will experience both or either forms of
addiction as the result of abuse of a drug.
A significant number of people turn to substance abuse when experiencing complicated grief. This is a term describing an extended period of unabated grief – pain that doesn’t get better even after many months or even years, and can actually get worse as time goes on. The Diagnostic and Statistical Manual of Mental Disorders refers to this as persistent complex bereavement disorder. According to a report published in the National U.S. Library of Medicine, around 10 percent of bereaved persons will experience this disorder. Like those experiencing chronic physical pain, they may self-medicate with alcohol or drugs and become dependent and/or addicted.
Common reasons people abuse substances while grieving include:
- To numb or distract themselves from the pain
- To help block out memories of the deceased
- To hide emotions, especially in men who feel that crying is a sign of weakness
- To help get emotions out if they’re experiencing unwanted numbness
- To punish themselves if they’re experiencing guilt
It’s also more common to engage in excessively risky behavior during the grieving process. With substances, this includes heavy use, mixing different substances, taking drugs they would normally never touch, and engaging in risky behaviors while intoxicated.
The consequences of this abuse can cause even more problems, whether it’s legally, financially, health-wise, or with loved ones, sending the bereaved individual further into substance abuse and dependence. This can result in a spiral of problems caused by addiction that makes said problems worse.
If grief doesn’t fade over time, or if you find you can’t seem to make it through the day without an addictive substance, it’s time to get help. There are plenty of health professionals who are trained to deal with grief, addiction, or both.
Unfortunately, there’s a strong stigma in our society against seeking mental health treatment. Being unable to stop grieving or overcome addiction on one’s own is often considered to be a weakness of character by many, and this can be especially true for men. However, complicated grief and addiction are illnesses, and it was estimated that 43.6 million people age 18 or older had some type of mental illness in 2014. These sicknesses alter your brain chemistry in ways you can’t control. In fact, it’s been argued that grief itself shares many key characteristics with physical illness. You can’t will yourself to stop having a condition like appendicitis; you need a health professional to help you fix the problem. It’s the same with mental illness.
There are several treatment options you can consider, including different kinds of therapy and medications. Treatment options include:
- Antidepressants: SSRI antidepressants can be used to balance out serotonin and allow the bereaved individual to experience pleasure and joy once again. They can also help someone struggling with addiction to deal with the psychological effects of withdrawal.
- Grief counseling: Many people find it helpful just to be able to find a safe space where they can share their honest feelings around loss without fear of judgment. Individual and group therapies for grief and addiction are fairly common and easy to find.
- Cognitive Behavioral Therapy: Learning to change one’s thoughts and behavioral patterns can end the cycle of grief as well as isolating behaviors. It’s also a commonly used and effective treatment for addiction.
- Nutritional programs: If grief has led to depression, changes in a person’s nutrition and exercise habits can help give them a jumpstart in serotonin and dopamine to increase pleasure responses, energy, and positive thinking.
- Medically supervised detox and rehab: Addiction is incredibly difficult to tackle on your own. Detox is uncomfortable and can be dangerous, particularly when it comes to alcohol, opiates, and benzodiazepines. Addiction treatment centers know exactly how to handle withdrawal and cravings, and they know how to reduce the high risk of relapse.
- Complicated grief therapy: There’s a special type of therapy designed to deal with complicated grief. It uses techniques similar to those that treat post-traumatic stress disorder (PTSD) to help process old emotions and come up with healthy coping techniques.
The more serious the condition, the more important it is to seek treatment. Untreated addiction can lead to serious health problems and risk of overdose, and untreated complicated grief carries the danger of suicidal thoughts and urges.
Complicated Grief Treatment
Every person experiences grief, complicated or otherwise, differently. It’s therefore important to note that each treatment program needs to be tailored to the individual. However, there’s strong evidence to suggest the effectiveness of Complicated Grief Treatment (CGT), which was developed by M. Katherine Shear, MD. According to a study in the Journal of the American Medical Association, people with complicated grief responded 51 percent better to specialized therapy than to standard interpersonal psychotherapy.
To be diagnosed with complicated grief, an individual generally needs to exhibit a number of specific symptoms. For most mental health professionals, this includes:
- Separation distress: The bereaved experiences intense and persistent feelings of longing for the deceased, feelings of loneliness or emptiness, urges to “join” the deceased (suicidal ideation), and/or frequent thoughts about the deceased to the point that it impairs daily functioning.
- Maladaptive thoughts: The bereaved finds it difficult to stop thinking about the circumstances around the loved one’s death and/or cannot accept that the loved one is gone.
- Emotional and cognitive reactions: Persistent feelings of shock, numbness, anger, or bitterness since the event of death, difficulty trusting others, intense reactions to triggered memories of the loved one, unexplained physical pain, and/or hearing or seeing the deceased (hallucinations).
- Unhealthy behaviors: Excessive avoidance of people, places, or things related to the deceased, or being unable to stay away from the same.
CGT happens in two distinct phases: helping the person come to terms with the loss and creating a sense of meaning and purpose in the person’s life without the deceased. Roleplaying or even hypnosis may be used to help the individual revisit the time of death, and dig up and process the unresolved feelings around this moment. Unresolved emotions tend to fester in the psyche, creating ongoing emotional problems and, sometimes, physical symptoms. Once the sadness, anger, and/or guilt around the death are processed in a safe, guided environment, the person can begin to reengage with whatever stimuli trigger memories of the deceased and practice coping mechanisms for whatever unpleasant emotions remain.
Substance Detox and Rehabilitation
It’s not easy to get on the road to recovery once someone has developed an addiction, especially if substance abuse was caused by a negative life event like loss. Reminders of the loss can trigger a relapse, and if grief hasn’t been resolved, it may feel like the pain can’t be stopped without a substance of some kind.
At the same time, substance abuse can make it more difficult to process grief and begin to heal. In a situation like this, it helps immensely to seek help from medical professionals who are trained and experienced in detox and rehabilitation services.
In medically supervised detox, addicted individuals are checked into a hospital or specialized center so doctors can monitor their vital signs in case dangerous withdrawal symptoms appear. Medical professionals are also trained to be on the lookout for any signs of discomfort in clients, which are taken as a signal that the treatment may need to be adjusted. Everything is done to keep the individual as comfortable as possible. Medication may be used to reduce cravings, control anxiety, and eliminate pain.
Once detox is complete, it’s highly recommended that people proceed into a professional rehabilitation program. Rehab is designed to help clients get through the first couple weeks to months without any intoxicating substances and to teach them coping skills to deal with the many situations that can trigger a relapse. Potential triggers can include friends offering them drugs or alcohol, attending events where the substance is available, or, in the case of a bereaved individual, something that triggers a memory of the deceased. According to studies, relapse rates for those who get some kind of addiction treatment after detox are anywhere from 20-50 percent, while those who don’t get treatment have relapse rates of 50-80 percent or even higher.
Interestingly, some individuals who go through detox experience a sense of loss and their own period of grief. The loss of the substance they were dependent on and the comfort it brought them, as well as loss of the lifestyle and friends they made during substance abuse, can create a unique kind of grief that needs to be treated. Failure to acknowledge or treat these emotions can increase the risk of relapse.
Health professionals can also help addicted individuals plan out long-term treatment programs. Addiction cannot be cured – someone who has chosen the path of abstinence will always be vulnerable to falling back into substance abuse and dependence. However, long-term attendance of therapy sessions or addiction support group meetings significantly decreases the chances of relapse. Therapy is especially recommended for those still going through grief or afflicted with complicated grief, as continued suffering makes relapse all the more tempting.