People who are dealing with grief sometimes turn to substances of abuse to numb their pain. With repeated abuse, addiction can quickly take hold.
Most rehab centers treat the entire individual, addressing all co-occurring issues, including grief. It’s important to fully deal with grief in therapy. Otherwise, relapse to substance abuse is likely following detox.
What Is Grief?
Grief is a reaction to a perceived loss that consists of symptoms that are often associated with major depressive disorder. They include sadness, feelings of despair, reduced appetite, reduced sleep, and a loss of interest in activities that were once enjoyable.
Everyone will experience some level of grief in life. Unless grief is prolonged and significantly dysfunctional, it is not diagnosed as a form of mental illness.
People experience grief associated with a loss that significantly affects them, such as loss of a job or possessions due to financial ruin or accident. Bereavement is a type of grief related to the loss of a person, animal, or object.
Stages of Grief
Quite a few different models attempt to explain the grieving process in terms of steps or stages that one transitions through. The most famous of them is the five-stage model of grief proposed by psychologist Elisabeth Kubler-Ross. She based her model on individuals who were diagnosed with terminal cancer and their reactions to the diagnosis.
The five-stage model includes:
- Denial. This is the initial reaction to the significant loss.
- Anger. Feelings of anger are then aimed at the situation.
- Bargaining. The individual then seeks to bargain with some higher power to change the situation that is producing grief.
- Depression. Next, the person begins to experience depression associated with their feelings of loss.
- Acceptance. Finally, the situation is resolved, and the person accepts what has happened.
Is the Kubler-Ross Model Valid?
Even though this is the most widely known model of the grieving process, very little empirical evidence suggests that individuals go through the process of grieving in this manner. Kubler-Ross based her model on a very select group of people.
Many people experience some of the phases described in the model, but they often do not occur in the order suggested. Many people do not experience all the stages. Some individuals experience other emotions, such as guilt or regret, as a part of the grieving process.
Grief Is Not Depression
A major element of sadness is associated with the experience of grief.
Even though the grieving process often resembles major depressive disorder (MDD) in many individuals, it is not diagnosed as MDD. Individuals with significant grief may develop MDD later on, but initially, clinicians will most likely diagnose them with a grief reaction.
They may treat the issue similarly to MDD, but they allow the individual time to express their feelings. They will validate their feelings as opposed to using cognitive restructuring techniques to change them.
Because the grieving process is considered to be a normal reaction to loss, treatment initially focuses on allowing individuals to work through their grief, express their emotions, and understand that their feelings are valid.
Is Grief a Disorder?
Mental health clinicians have avoided specifying normal grief reactions as formal psychiatric disorders up to this point. However, the actual boundaries that define “normal” grief from prolonged or complex feelings of grief are not universally accepted.
Traditionally, clinicians used a six-month period after the experience of loss to designate the span of the “normal” grieving process. As might be expected, such a limit on the timeframe for grief has received quite a bit of criticism. The current timeframe for the normal grieving process is considered to be anywhere between a couple of months to one year.
The American Psychiatric Association (APA) has proposed a set of diagnostic criteria for a persistent complex bereavement disorder that occurs when grief or bereavement becomes prolonged, significantly dysfunctional, and goes beyond what would normally be expected of a grieving individual. Even this potential diagnosis, which is not yet accepted as a formal disorder but is a condition for further study, has generated criticism.
At the current time, there are no universally accepted boundaries for designating what constitutes “normal” grief and what separates it from dysfunctional grief. The designation between normal grief or bereavement and dysfunctional grief or bereavement is usually considered on a case-by-case basis.
The Connection Between Substance Abuse and Grief
A serious repercussion of grief, particularly bereavement, is a vulnerability to abusing drugs or alcohol.
There are no well-established figures that are available to determine the prevalence of co-occurring grief and a substance use disorder, but individuals with MDD are five times more likely to develop a substance use disorder than people without any kind of mental health disorder.
Individuals who are struggling from significant grief are likely to be at significant risk to develop substance abuse issues. Alcohol abuse is the most likely form of substance abuse in most of these cases, although other drugs are also abused.
Are There Rehabs That Specialize in Grief?
Because grieving is considered to be a relatively normal reaction to a significant loss, most drug rehab programs do not specialize in treating co-occurring grief and substance abuse, but they would be able to address both situations simultaneously.
Individuals who have prolonged grief (longer than six months to a year) or experience extremely intense symptoms and also have a co-occurring substance use disorder would most likely be treated similarly to individuals with MDD and co-occurring substance abuse.
Treatment involves addressing the grief, letting the person discuss their feelings openly, and helping them adjust to the loss. Therapists will help them accept the loss and function in spite of it. In addition, the person will undergo the protocol for formal substance use disorder treatment.
It’s preferable to avoid the use of antidepressants or other medications in addressing grief unless the symptoms are extremely intense.
Rehabs that treat dual diagnosis should be able to accommodate someone who is suffering from both grief and substance abuse.
The relationship between depression, grief, and substance abuse is very complicated. Rehabs develop a very personalized approach to addressing each person’s needs. This involves the use of a formal assessment for treatment, the development of a treatment plan, and flexibility to adjust it based on the person’s progress.
A General Protocol to Address Grief and Substance Abuse
The overall protocol to address co-occurring grief and substance abuse would consist of many factors.
- A thorough assessment of the person’s functioning across psychological, physical, and social domains
- The development of a treatment plan to fit the findings from the assessment
- Medical detox, if deemed appropriate
- Medications for severe symptoms of depression, anxiety, suicidality, and other symptoms associated with the grieving process
- Substance use disorder therapy and grief counseling
- Participation in peer support groups
- Significant support from family and friends, including family therapy when appropriate)
- Mild exercise programs to promote overall wellness
The overall goals of treatment for addiction and grief are to promote long-term abstinence, help the individual work their way through the grieving process, and provide them with understanding and support.