Grief & Addiction

Symptoms of Grief

Symptoms of grief include the following:

• Feelings of intense melancholy or sorrow 
• Sleep problems and sleep disorders 
• Depression
• Lack of drive
• Inability to focus

Certain types of grief can have negative effects on a person’s physiology, causing conditions like these:

• Inflammation 
• Gastrointestinal problems
• Headaches 
• Joint pain

Grief is associated with loss, which can occur due to many circumstances. Forms of loss include loss of a family member, loss of a job, a divorce or breakup, and loss of possessions, all resulting in grief for the person experiencing it. The way someone reacts to times of grief varies greatly from person to person.

Certain individuals may indulge in substance abuse as a way to cope with their troubles, with some returning to substances they used prior in their lives and some turning to substance use for the first time after experiencing a negative life event.

Different Types of Grief

There are different types of grief that a person can experience throughout their lives, in some cases multiple times. Forms of grief include the following:

• Anticipatory grief
• Inhibited grief
• Absent grief
• Delayed grief
• Disenfranchised grief
• Chronic grief
• Cumulative grief
• Traumatic grief
• Complicated grief
• Persistent complex bereavement disorder

Of course, there are additional forms of grief, but the forms of grief listed above are the most prevalent. All forms of grief can lead to co-occurring substance use disorders.

Anticipatory Grief

Some types of loss or grief we experience are due to events that we know are going to happen ahead of time. For instance, you might have a friend or family member who has a terminal illness, which can cause feelings of anticipatory grief.

Inhibited Grief

Certain individuals repress emotions related to grief, which is considered inhibited grief. Although the person experiencing this type of grief might not show signs of depression, they can exhibit other symptoms, such as loss of appetite, lack of sleep, or lack of focus.

Absent Grief

Going a step beyond inhibited grief, absent grief is characterized by showing no signs of grief or few signs of grief at all.

Delayed Grief

A person experiences delayed grief when an emotional reaction occurs either days, weeks, months, or even years after the event.

Disenfranchised Grief

Disenfranchised grief is compounded grief that occurs when those close to the person in question do not understand or empathize with some form of grief they are experiencing. Disenfranchised grief may be due to the person who is grieving having specific expectations of how those around them should treat them while they grieve.

Chronic Grief

Chronic grief is among the more complicated forms of grief. Individuals experience grief that persists and does not subside, even after years. Chronic grief can intensify over time.

Cumulative Grief

Cumulative grief occurs when multiple traumatic events or experiences of loss happen within a short period. This form of grief is also commonly referred to as bereavement overload.

Traumatic Grief

Traumatic grief is generally connected to the unexpected loss of a friend or loved one. Individuals who experience traumatic grief might be processing another form of grief simultaneously, creating grief that compounds over time. Those who experience traumatic grief might also experience survivor’s guilt.

Complicated Grief

Complicated grief involves prolonged feelings of loss. People with this form of grief often think about what they could have done differently, and they spend long periods thinking about the circumstances of the loss. They may struggle to regulate their emotions, and they may feel isolated and lost in their grief.

Substance abuse is a risk factor for complicated grief. People who numb their emotions with substances aren’t able to process them in a timely way. Similarly, substance use can be caused by complex grief, as people lean on drugs and alcohol to relieve their relentless memories and difficult emotions.

Persistent Complex Bereavement Disorder (PCBD)

People with PCBD have experienced the death of a close loved one, and they experience extreme distress that persists for at least 12 months. People like this may show outward signs (like crying), or their symptoms may be internal (like suicidal thoughts).

Experts say PCBD is closely related to substance use. Many people with this condition lean on addictive substances to ease their symptoms, and as their addictions worsen, their overall mental health declines.

Causes of Grief

Grief can be caused by a variety of factors, including these:

• Death of a friend or loved one
• Death of a pet
• Loss of employment
• Financial struggles
• Divorce or separation
• Relationship issues

Grief can sometimes result from feelings of inadequacy or poor decision-making. People can also experience grief from circumstances and conditions that are beyond control, such as the aging process.

Substance abuse in itself can cause grief. When a person is struggling with an addiction, they might have feelings of letting people down and not being good enough. Family members and friends might not know how to appropriately deal with someone in the throes of an addiction, and this can compound feelings of grief. Unresolved grief can impact addiction as well.

How Grief Affects Mental Health

Prolonged grief disorder was added to the Diagnostic and Statistical Manual of Mental Disorders in 2021, illuminating the connection between grief and mental health. Experiencing any kind of grief can affect a person’s mental health in numerous ways, resulting in depression, mood disorders, eating disorders, anxiety disorders, and other mental health problems.

The effects grief has on a person can also affect mental health. Sleep disorders caused by grief can negatively impact mental health. Grief can also cause poor performance at work and outside of work, which can certainly affect a person’s mental health.

Grief, Substance Use & Addiction

In many cases, grief is not properly processed when experienced alongside a substance abuse problem or drug addiction.

Resorting to substance abuse in times of grief can often augment symptoms and create new grief. In many cases, individuals who are struggling with substance abuse and addiction make impulsive decisions that will only complicate the situation further.

Unresolved grief and related depression can increase vulnerability to substance abuse and drug addiction. Often, individuals experiencing various forms of grief will decide to self-medicate, most often with substances like alcohol, marijuana, or even more serious controlled substances like heroin or amphetamines.

People who go through grief might also abuse prescription drugs, whether they are prescribed the drug in question or not.

Stages of Grief & Substance Abuse

The process of treating a substance abuse problem or addiction involves both mourning and recovery. There are many parallels between attachments to loved ones and attachments to controlled substances. Even the early feelings associated with falling in love (euphoria and increasing preoccupations) are also associated with the feelings associated with drug use early on.

Elisabeth Kübler-Ross, a Swiss American psychiatrist, did a significant amount of work analyzing grief and proposed the five stages of grief. These stages are also inextricably linked to substance abuse and addiction. Grief stages include denial, anger, bargaining, depression, and ultimately acceptance.

When an individual allows themselves to process and undergo each stage of grief, whether dealing with trauma or a substance abuse problem, they are more likely to process the situation healthily while abstaining from controlled substances.

What to Do When You Recognize Grief & Addiction

Grief and addiction are often intertwined, making your recovery more complicated. However, you can take positive steps to change your life and improve your mental health.

Rather than leaning on substances to blunt your grief, try the following suggestions:

• Create a community. Find friends or relatives who understand your feelings of loss. Tell them how you’re feeling.
• Care for your body. Get regular exercise, eat well, and set a realistic sleep schedule.
• Don’t make major life changes. It’s not a good time to move, remarry, change jobs, or otherwise disrupt your life. Let yourself feel your feelings.
• Be patient. Recovering from a loss can take months or years. Make an effort to live in the present, but know you may struggle for a while.

You may need professional help to process your grief. The American Cancer Society says bereavement counseling is offered through hospice organizations for up to 13 months. If the person you lost was in hospice, this could be a good place to start.

If the person you lost wasn’t connected with hospice, your family doctor may be a good resource for information. Your doctor can also connect you with appropriate, compassionate care for your addiction.

The following resources may also be helpful:

• National Helpline from the Substance Abuse and Mental Health Services Administration (SAMHSA): Call 1-800-662-HELP for referrals to addiction treatment or mental health providers.
• Helpline from the National Alliance on Mental Illness: Call 1-800-950-NAMI or text “helpline” to 62640. Connect with a volunteer who can listen, offer support, and connect you with resources.
• Crisis Text Line: Help is available via text, chat, and WhatsApp around the clock. Trained crisis counselors can help you through difficult moments and help you find support.
• GriefShare: Use this platform to find grief support group meetings in your area held in places like churches and hospitals.

Treatment for Grief & Substance Abuse

Treatment for grief and substance abuse varies from individual to individual, and each treatment plan should be catered to the individual’s needs. Generally, treatment for both grief and substance abuse includes therapy, prescription medication, rehabilitation, and additional supportive options.

While individuals without co-occurring substance abuse issues can process grief in healthy ways like exercise, eating healthy, getting regular sleep, and talking to a therapist or loved one, those who have a substance abuse problem are less likely to pursue these healthier avenues. Instead, they generally turn to more substance abuse in an effort to escape the painful feelings of grief.

It’s imperative that grief and substance abuse are treated simultaneously with treatment for co-occurring disorders. If only grief or substance abuse are addressed individually, the individual is unlikely to experience recovery and stability on either front.

Medications may be needed for both conditions — medication-assisted treatment (MAT) to treat some forms of substance use disorder and antidepressants or other medications to address symptoms of grief. Other medications may be prescribed to address specific symptoms like insomnia or panic attacks.

Therapy is the cornerstone of co-occurring disorders treatment. In therapy, either individual or group, participants will learn to process their grief and identify triggers related to substance abuse. They’ll build healthy coping mechanisms, identify damaging thought patterns, and learn new behavioral responses to help them embrace a healthy life in recovery.

What to Expect in Treatment

Every treatment program for grief and addiction is a little different, but most follow the same steps. Understanding what they are might help you feel more comfortable asking for the help you need.

These are the steps that are typically involved:

1. Find a Provider

You can ask your doctor, contact your insurance company, or search the internet for professionals who specialize in treating grief and addiction. Good questions to consider as you search include the following:

• Does this provider have experience in treating my type of substance use?
• Does this organization use evidence-based practices (like medications to treat opioid addictions)?
• How soon can treatment begin?
• Is the facility licensed and credentialed?
• Is the provider board-certified in addiction medicine or addiction psychiatry?
• Are treatment plans personalized and based on an assessment?
• How are underlying mental health issues, like grief, addressed in an addiction plan?
• How much will treatment cost, and will my insurance policy help?

2. Complete an Assessment

Before your treatment begins, your provider should have a complete understanding of your physical and mental health. You may be asked several questions about your drug use, your thought patterns, your coping skills, and your current state of mind.

Your team may also ask for physical screenings, such as drug tests. Some providers offer these directly, while others might ask you to work with your doctor to get accurate results.

3. Craft a Plan

With your assessment complete, your team can create a treatment roadmap just for you. It could include drug detox, rehab, counseling, support groups, and more. It could also include just a few of these elements and not others.

Ensure that you understand the plan and accept it. You’re an active participant in your recovery and have the right to ask for changes.

4. Start Treatment

Once you’ve accepted the treatment plan, it’s time to get started. Stay in close contact with your treatment team about your progress and how you’re feeling. Know that you can change your plan at any point if you don’t think it’s working.