From a clinical perspective, grief is a normal reaction to any significant loss.

When experiencing grief, an individual may manifest a range of symptoms of an emotional, social and physical nature.

Grief is a well-studied reaction, and there is a consensus in the mental health community that grief involves the following seven emotional stages:

  • Shock or disbelief
  • Denial
  • Bargaining
  • Guilt
  • Anger
  • Depression
  • Acceptance or hope

The Great Weight of Grief

In some cases, the grief process can become abnormal or atypical. For instance, prolonged grief is that which lasts more than one year and affects important facets of the grieving person’s life like work, relationships, thoughts and beliefs. Approximately 15 percent of individuals will experience complicated grief after experiencing a grief trigger, such as the loss of a loved one. Of those bereaved individuals who are already in the process of seeking mental health services, approximately 33 percent have been found to be suffering from prolonged grief.

There is an ongoing debate in the mental health community as to whether or not grief is a mental illness. Clinicians who see grief as a mental illness are more likely than those who do not to prescribe pharmacological interventions. Some clinicians may prescribe antidepressants, or other medications, to treat grief. But wherever a mental health professional stands on how to clinically characterize grief, there is a strong consensus that psychotherapy is necessary. Research, clinical experience, and patient feedback support that grief is treatable, at least in part, with psychotherapy.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), currently in its 5th edition (published in 2013), is known as the “psychiatrist’s and psychologist’s bible” because it classifies and provides encyclopedia-like information on every officially recognized mental health disorder. The American Psychiatric Association, the publishers of the DSM-5, specifically set out to help clinicians distinguish between individuals suffering from “normal” bereavement and those experiencing a mental disorder such as major depressive disorder (MDD).

The overlap of the features of “normal” grief with MDD presents a challenge to proper diagnosis and, by extension, application of appropriate treatment protocols. Also, in some cases, the experience of a significant loss can trigger a dormant mental health disorder to become expressed. In that event, the mental health disorder will require treatment separately from the grief experience. It is clear that grief can be a complicated experience, not only emotionally, but psychiatrically as well.

Grief and Substance Abuse Prevention

The experience of a significant loss can blindside anyone at any time. Even if grief is anticipated, such as in the case of a terminally ill loved one, no one knows how they will react to the loss when it actually occurs. When grief crashed into someone’s life, it takes them as they are, whether they have a lifetime of being sober, are in alcohol or other drug recovery, or are currently abusing alcohol or other drugs. Grief can trigger one to initiate into drug use for the first time, instigate a relapse, or further fuel existing drug abuse.

Drug abuse prevention efforts may be required for a person who has never abused drugs or for those who are in recovery (whether it has been three days or three decades). Although grief often plunges people into a state of profound confusion, there are ways to recover one’s grip on reality and grieve in the healthiest way possible.

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides the following guidance on how to cope with grief in a way that will minimize initiating into drug use or relapsing:

  • Accept the reality of the loss.
  • Confront the grief and work through it.
  • Make efforts to adjust to reality/life after the loss.
  • Move forward with your life.

The SAMHSA guidance is broad, so as to be applicable to many, but there is also specific advice on actions one can take to affirmatively prevent drug use when experiencing grief.

The following are some helpful steps that can be taken:

  • Draw support from others. Grief can drive a person into hiding, as a coping strategy, but the healthier practice is to be social with loved ones and allow them to help out.
  • Engage your faith. For those who identify with a certain faith, even if they have been away from the practice of it, re-connecting with the organization and its members can provide guidance and support.
  • Join a support group. Grief can make a person feel acutely alone, but that’s never the case. A local support group organized around grief or the type of loss experienced can be very nurturing, supportive and helpful.
  • Express the grief. Acknowledgement of grief opens the pathway to heal it, and there are numerous avenues to allow for expression, such as art therapy and journaling.
  • Know that time can be healing. Although grief may feel endless, it is a temporary experience. Keeping this thought at the forefront of one’s mind and knowing that happiness will come again in the future can be helpful.

Grief can overwhelm a person’s life, and while it may seem as if things could get no worse, they unfortunately always can. It is for this reason that a grieving person, as well as loved ones around him, is best advised to make efforts to prevent the grief from spiraling out and collecting force from harmful experiences like drug use. The grief itself should never be minimized, but its reach should be contained to avoid a worsening of emotions and personal circumstances.

In addition to receiving structured treatment from a therapist, a grieving person may find comfort in personal efforts. It can be helpful to read non-fiction accounts of other people’s experiences with grief, especially those who went through the process entirely sober. Renowned author Joan Didion penned such a book, the bestseller The Year of Magical Thinking, after the loss of her husband. The book successfully transports the reader into Didion’s grieving mind. Though Didion is a respected author, she honestly presents how grief ravaged her mind, and caused her think in a manner that was abnormal for her. Didion recovered, accepted the loss, and then compellingly recounted it in this memoir.

Grief in Drug Rehab

In some cases, a person will be in a drug recovery progress when the grief event occurs or past grief rises to the surface. This is a unique clinical scenario, and treatment professionals will need to adequately respond with a blended substance abuse and grief therapy approach.

Licensed clinical social worker Mark Sanders states that drug addiction treatment is most effective when it takes on the recovering person’s grief experiences, whether they are past or present. Taking drugs can be like sticking a finger in the hole of an emotional dam that is ready to burst. As soon as the drug use stops, grief may burst forth uncontrollably. For this reason, Sanders believes that addressing grief can help to facilitate long-term recovery.

Sanders advises that addiction health professionals who are also treating grief should possess certain qualities, such as:

  • Grief competency: Addiction counselors should themselves be in the habit of taking inventory of their losses and grief, and healthily processing those feelings so they are able to receive the grief of others and help them to work through it.
  • Familiarity with forms of grief: There are numerous forms of grief, and an astute counselor will not only be able to identify them but also help clients to successfully work through them.
  • Compassion and nonjudgment: Grief can erect barriers to treatment, but a counselor who actively listens nonjudgmentally and provides a comfortable setting is best positioned to build trust with the grieving person and draw her grief into conversation.
  • Grief is individualized: Although the seven stages of grief are an accepted psychological occurrence, it is critical for therapists and clients to understand that not every person goes through each stage or does so in the same order or at the same pace.

A person in drug rehab who is grieving a present loss, whether it is recent or it occurred during the rehab stay, will either receive help from the addiction treatment professionals on staff or from a local grief counseling specialist working in conjunction with the rehab center. In the case where normal grief and substance abuse occur at the same time, treatment professionals will likely combine the appropriate drug treatment protocols with traditional grief counseling techniques.

In the case where prolonged grief is present, or the grief event triggers an underlying mental health disorder such as depression, the recovering person may receive a dual diagnosis. As Everyday Health notes, approximately 20 percent of individuals with anxiety or a mood disorder, such as clinical depression, also have a substance abuse disorder. In such cases, a psychiatrist will be involved in treatment and may prescribe medication, like antidepressants. Grief treatment approaches should still be provided, because a grief event did occur, but they will likely be supplemented with prescription mood disorder medication or at least the advisement to take such medication.

Counseling for Prolonged Grief

The experience of grief is always highly personalized and so is treatment. Of course, not everyone who grieves will seek formal counseling, but some of those who do will be diagnosed as suffering from prolonged grief or complicated grief. Treatment for prolonged grief is a necessary intervention method to stop the grief from becoming more acute, worsening over time, or developing into a separate mental illness. Again, the presence of grief is never a barrier to substance abuse treatment, and grief can always be treated in conjunction with substance abuse.

To treat grief, psychotherapists will draw from current, peer-reviewed, and scientifically backed treatment approaches. According to Psychology Today, the following therapy approaches are particularly suitable to treatment of prolonged grief: Cognitive Behavioral Therapy (CBT), exposure therapy and meaning therapy.

CBT can treat the irrational thoughts that occur around the grieving person’s loss. A grieving person may unwittingly adopt thoughts and beliefs that perpetuate their grief and even derive pleasure from this process because it keeps him close to the person or status that was lost. For instance, in the case of a death, rather than seeing the death as a meaningful part of the life cycle, the grieving person may take it is a sign that life is meaningless, which fuels depressive thoughts and actions. CBT can help a grieving person to identify the ways in which he is fueling the cycle. A second step is to develop behavioral strategies that support letting go, moving on, and living a happy life despite the loss. CBT is often used in the drug treatment context, and therefore, it can used to treat grief and drug recovery together.

Exposure therapy can be used to expand a grieving person’s perspective. Grief can cause a person to focus nearly exclusively on who or what was lost. During exposure therapy, the psychotherapist can help the grieving person to see the full picture – all the people, places, and events that make up life around her. One goal of this therapy approach is to help grieving persons to break habits that keep them entrenched in the grieving process, such as carrying excessive reminders of the person, place, or circumstance that was lost. This could mean, for instance, removing a deceased person’s everyday effects from a shared medicine cabinet or closet.

Meaning therapy focuses on making sense of the loss. When a traumatic event happens, healing can be aided through creating a philosophical framework that makes the experience make greater sense. This approach can help a grieving person to understand that loss can provide an opportunity to deepen his understanding of his own life and the universe as a whole. Grief is only one outcome of loss; another possibility is that the mind turns to greater understanding and life appreciation.

Light at the End of the Tunnel

It may seem radical when grief is at its peak, but when the worst of it subsides, the grieving person may even come to see grief as a great teacher. Whether grief is normal or complicated and diagnosed as prolonged grief, it is a treatable condition. Substance abuse is also treatable. Although from within the trenches of grief or substance abuse, one may feel hopeless, there is always hope because recovery is always possible.

The addiction and mental health professionals at Black Bear Lodge are experts in the field and appreciate decades of clinical experience. Our present and past patients come from every corner of America and from all over the globe. We are experienced in treating substance abuse concurrently with grief, prolonged grief, and/or mental health disorders. Our clinical experience with grief provides us with the insight to effectively treat the issue while also delivering high-level drug rehab services. We are committed to treating the totality of our patients’ needs, including any past or present experiences with grief. Call us at 706-914-2327 to learn more.