“Grief is the price we pay for love.” ~ Queen Elizabeth II

Family members of those suffering with a Substance Use Disorder (SUD) may not be aware of the pivotal role that grief plays in their experience.

We tend to consider grief as a natural reaction to a particular set of conditions. For example, it is acceptable to grieve when a loved one dies, a marriage breaks down, someone moves away, or an important job is lost. However, it is important to understand that grief also occurs when someone loses a way of life or when a relationship to a loved one dramatically alters.

When someone close to us is struggling with an SUD, symptoms of grief emerge in response to the intense changes taking place both in an individual and in the family dynamic. Through understanding and accepting the grief, it is possible to develop coping strategies so that it does not have a long-term impact on well-being and mental health.

The Five Stages of Grief

The Five Stages of Grief were devised by Dr. Elizabeth Kubler-Ross’ and outlined in her renowned books On Death and Dying and On Grief & Grieving.

When a loved one has an SUD, these stages can become unpredictable, so the process involves time, patience, and understanding. Stages can occur out of sync, be missed altogether, or become extended.

The Five Stages are:^[1]

1. Denial 
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Grieving for your loved one, the loss of a relationship, and for the impact it has on you require support from others and maintaining a high level of self-care and self-acceptance.

Types of Grief

There are two key types of grief that a person may experience:^[2]

• Anticipatory Grief – This grief arises as we notice the person changing. We may witness the decline of their health, the formation of negative characteristics, or a separation or distancing of the person from their loved ones.  We experience a sense of loss not only in our direct experience but also in how we visualize the situation worsening.
• Secondary Loss – Secondary loss can occur months or even years after the experience itself. Grief can arise in response to painful memories of the situation and the person in question.

Coming to terms with grief is complicated and challenging for all involved. Grief has no fixed time, and the symptoms of mourning the loss vary significantly from person to person

Symptoms of Grief

Grieving is the outward expression of loss and is characterized physically, emotionally, and psychologically. Grief is unique to the individual, and emotions will rise and fall both in pattern and intensity. Common feelings include:^[3]

• Guilt, regret, overwhelm
• Shock, numbness
• Sadness, episodes of crying
• Fear, panic
• Frustration, agitation 
• Mental and physical exhaustion
• Insomnia, nightmares
• Anger with yourself or the loved one 

Symptoms of grief, although natural, are distressing and uncomfortable. It is vital to remember that, as with all feelings, they can depart just as they arrived. As demonstrated through the Five Stages of Grief, this is a universal emotion, and it is important to not lose sight of a brighter future. However, in some instances an individual may develop a grief disorder which can make life extremely unpleasant and feel untenable. 

What is a Grief Disorder?

Grief can impact all aspects of a person’s mental health and, for those with a pre-existing mental health condition, they may notice a decline while others may develop a specific mental health disorder as a result of the grief symptoms.^[4]  

The Five Stages of Grief can be more intense and prolonged for some people, and the combined feelings of loneliness, sadness, hopelessness, anger, and anxiety can become so overwhelming and severe that a grief disorder can occur.^[5] Research has evidenced that approximately 20% of grief sufferers will experience an extended period of complicated bereavement and are at risk of developing chronic grief.^[6] These individuals require therapeutic support and specialist treatment in order to heal.  

It is widely considered that for those grieving for a loved one who is still alive, the chances of developing a Grief Disorder, also known as Complicated Grief Disorder or Traumatic or Prolonged Grief, increases.^[7]

The propensity for the condition is elevated due to the prolonged combination of both anticipatory and secondary grief. Often a family will witness the decline of a loved one with an SUD for a number of years before they even begin the recovery journey. The recovery journey is, then, only the beginning of the path and brings with it numerous challenges, hurdles, and changes to contend with and accept.

Grief is present at almost every stage of the process, and feelings such as anxiety, depression, anger, bitterness, nihilism, and a powerful pining for the previous version of a loved one can exacerbate the condition.

As with all mental health conditions, swift intervention is crucial for supporting the individual in maintaining a healthy, happy, and fulfilling life. 

Strategies for Coping with Grief

Finding and practicing healthy coping strategies to combat the symptoms of grief is essential for both the individual suffering with the SUD and for their loved ones. By accepting the losses and understanding the changes in relationship dynamics and lifestyles, there is a greater chance for a long-lasting recovery and avoidance of relapse.

Despite the pain that grief causes, it is an important and essential part of processing loss and adapting to the new life in front of you. Here are five strategies to help you live with grief:

1. Health and Self-Care: Focus on the all-important mind body connection. Rest, exercise, and eat nutritious foods. Avoid alcohol or other substances as grief elevates the risk of forming a dependency. 
2. Express Yourself: The perpetuation of difficult emotions during the grief process can seem unbearable, and some people may attempt to suppress or numb themselves as a means of coping. In order to process the rising feelings, it is vital to express yourself to those you trust and to articulate the feelings to yourself through meditation, art, or journalling.
3. Postpone Major Life Changes – Postpone life changes and big decisions such as ending or starting a relationship, changing jobs or moving, as space and familiarity are essential in adjusting to the loss.
4. Anticipate Triggers: New waves of grief can be triggered by old memories, such as the passing of holiday days or the direct experience of change in your loved one, which prompts feelings of disconnect and sadness. Prepare for these triggers through talking to trusted friends, avoiding isolation, and planning a response.
5. Seek Support: If the grief is too overwhelming, you are feeling increasingly anxious or depressed, and/or you are experiencing thoughts of suicidal ideation or self-harm, please do not hesitate to seek professional therapeutic assistance and treatment.^[8] 

Grief for a loved one who is still alive and who is suffering from an SUD is uniquely difficult and challenging. There is no quick fix to grief, in particular the type of grief where a loved one is still alive, because the process requires patience, understanding, acceptance, and, most crucially, support.

We all experience loss differently; however, group and family therapy can be a powerful reminder that you are not alone in your experience. Even the most painful and disabling symptoms of grief can be overcome through early intervention and professional assistance.

If you or a loved one is struggling to cope with grief please please contact Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.

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Sources:

[1] Kübler-Ross, Elisabeth et al. On Grief & Grieving. Scribner, 2014.

[2] Bertuccio, Rebecca F., and Megan C. Runion. Considering Grief In Mental Health Outcomes Of COVID-19.. 2021.

[3] Bonanno, George A., and Matteo Malgaroli. “Trajectories of Grief: Comparing Symptoms from the DSM‐5 And ICD‐11 Diagnoses”. Depression And anxiety, vol 37, no. 1, 2019, pp. 17-25. Wiley, doi:10.1002/da.22902. Accessed 22 Apr 2021.

[4] Wilkinson, Stephen. “Is ‘Normal Grief’ a Mental Disorder?”. The Philosophical Quarterly, vol 50, no. 200, 2000, pp. 290-304. Oxford University Press (OUP), doi:10.1111/j.0031-8094.2000.00186.x. Accessed 22 Apr 2021.

[5] OTT, CAROL H. “THE IMPACT OF COMPLICATED GRIEF ON MENTAL AND PHYSICAL HEALTH AT VARIOUS POINTS IN THE BEREAVEMENT PROCESS”. Death Studies, vol 27, no. 3, 2003, pp. 249-272. Informa UK Limited, doi:10.1080/07481180302887. Accessed 22 Apr 2021.

“About Complicated Bereavement Disorder”. Psychology Today, 2013,

[6] https://www.psychologytoday.com/gb/blog/get-hardy/201309/about-complicated-bereavement-disorder-0.

[7] Hughes, Virginia. “Shades Of Grief”. Scientific American, 2013, https://www.scientificamerican.com/article/shades-of-grief/. Accessed 22 Apr 2021.

[8] Bryant, Richard A. et al. “Treating Prolonged Grief Disorder”. JAMA Psychiatry, vol 71, no. 12, 2014, p. 1332. American Medical Association (AMA), doi:10.1001/jamapsychiatry.2014.1600. Accessed 22 Apr 2021.