Some information on Grief and Substance abuse.

Dealing With Grief
The Symptoms, Stages and Triggers Surrounding The Grieving Process
TIAN DAYTON PhD TEP


GRIEF IS WIDELY ACCEPTED AS AN ISSUE that needs to be addressed during recovery.
While normal life losses do not necessarily benefit from nor require therapy, complicated loss
associated with addiction issues may benefit from professional help. Those developing treatment
programs, are oftentimes legitimately concerned about whether addressing powerful issues of
grief can undermine sobriety or open the door to relapse. Generally speaking, addicts need to
develop solid enough recovery and ego strength to allow them to experience the difficult
emotions associated with grief issues so that they don t relapse. In early recovery addicts may not
benefit from revisiting painful, historical material that can trigger relapse, while in later recovery
the opposite can be true. Avoiding painful material can actually undermine the recovering
person s ability to develop a consolidated sense of self, which can also lead to relapse. Some
lecturing on the grief process can actually normalize grief so that when it does emerge, it is
somewhat less derailing. Many addicts were themselves once hurt people, who relied on a
substance to deaden their pain. The grief issues that they have been self-medicating with drugs,
alcohol, food, sex, or gambling may eventually bubble to the surface during the recovery process.
In addition, they may need to grieve the years the lost through addiction and the pain that they
have caused those they love. And to complicate matters even further,they are likely to be grieving
these issues with a weakened set of psychological and emotional tools.
In the world of addiction, clients may find themselves feeling that they have no right to mourn
the loss of a problematic relationship, because they are "better off without them." But pain filled
relationships can be difficult to process simply because there is so much unfinished business
associated with them. Conflicting feelings, for example,of loving and hating, guilt and relief ,
may complicate their mourning process. Instilling hope and engaging the client with a recovery
zeal and a recovery network become very important in creating motivation and a safety net to
sustain and contain the grieving process.

A surprisingly large number of life's events go ungrieved in our futile attempt to "get on with life"
or to "stop feeling sorry for ourselves." Those events, which can be disavowed, may include any
of the following:
* divorce, for spouses, children and the family unit
* life transitions
* loss of job, youth, children in the home, retirement
* dysfunction in the home, loss of family life
* lost childhood, lost security, constant abandonment, loss of parents who were able to behave
like parents
* loss of a period of one s own lfe, loss of potential what might have been
If we cannot mourn losses, we may experience one or all of the following reactions:
* Stay stuck in anger, pain, and resentment
* Lose access to important parts of our inner, feeling world
* Have trouble engaging in new relationships because we are still engaged in an active
relationship with a person or situation that is no longer present
* Project unfelt, unresolved grief onto any situation, placing those feelings where they do not
belong
* Lose personal history along with the unmourned person or situation as part of us dies too
* Carry deep fears of subsequent abandonment

Grief and Self Medication
In his seminal research on trauma, Bessel van der Kolk (1987) found that one of the
pervading symptoms of post traumatic stress disorder (PTSD) in soldiers and those who have
experienced some form of familial trauma (such as physical, sexual, or emotional abuse, neglect
or living with addiction) is the desire to self-medicate with drugs or alcohol. People abusing
substances have been able to medicate pain associated with grief, often for periods of many years.
In sobriety, losses, which went ungrieved and were medicated rather than felt, understood, and
integrated, may resurface. Without the coping strategy of self-medication, the sober addict will
need to summon the strength to live through the pain that previously felt like too much to
tolerate.Experiencing these losses in recovery may be confusing for the addicted person because
often they reach back for years or even decades. Psychodrama can offer a way to concretize and
work with those overwhelming emotions when they surface. It is generally recommended that
sobriety be established before those feelings are worked with experimentially.

Terminal Uniqueness
It is not uncommon for those who carry deep grief, which they have not been able to resolve,
to feel that their grief is unique among all other types of grief and that no one can really
understand what they are going through. That reaction speaks to the trauma that they are
experiencing and their loss of ability to take in support from others. Terminal uniqueness often
has anger lingering around its edges. Engaging clients in the stages of grieving can help to move
them toward some resolution. Many of the exercises that I present here can help the grieving
person begin to shed the tears and express the angry feelings associated with grief and
simultaneously to accept caring and support from others. Working with photographs and keeping
a journal can also be useful in helping a grieving person to concretize a particular grief issue.
The following are warning signs of unresolved grief:
* Excessive guilt
* Excessive anger or sudden angry outbursts
* Recurring or long-lasting depression
* Care taking behavior
* Self-mutilation
* Emotional numbness or constriction

Stages of the Grieving Process
One can expect to pass through certain, predictable stages in experiencing and processing loss.
To adapted the process, I have adapted the stages offered by John Bowlby (needs citation and
reference) and added a fifth stage, which I have observed that clients move through when they
allow themselves to surrender to the process of grieving. Feelings do not necessarily follow an
exact course, but listing the stages offers an overall map of the emotional terrain generally
covered during the process of grieving loss. Loss here, refers to the loss of a person, a part of self,
a period of life, personal dreams or addictive behaviors or substances.
Emotional numbness and shutdown. In this stage, we may go through a period of
feeling emotionally numb. We know some thing happened, but our feelings are shutdown and out
of reach.
Yearning and searching. This stage is marked by a yearning for the lost object (person or
situation) and searching for it in other people, places, and things. Ghosting, or the sense of a continuing presence of the lost object or even a sense that one is seeing them, may be
experienced. There is deep yearning for what was lost-be it a stage of life, a part of the self, or a
person-followed by a searching for a way to replace the lost experience.
Disruption, anger, and despair. In this stage, clients may experience anger, despair, and
disappointment, which come and go and are overwhelming at times. Loses that have anger and
resentment attached to them can become complicated. There may also be ambivalent feelings of
missing and relief or rage and yearning. It may be easier for some clients to feel the anger, rather
than the sadness beneath it or the reverse.
Reorganization and integration. In this stage, the grieving person is able to articulate
and experience either the normal, numbed, or split-off emotion connected with the loss and
integrate it into the self system. One s inner world reorganizes with the loss incorporated into it.
This is the stage of acceptance and letting go.
Reinvestment, spiritual growth, and renewed commitment to life. In this stage,
one comes to believe in life's intrinsic ability to repair and rebuild itself. The grieving person
experiences this firsthand by reaching out and letting in love and caring from willing people and
realizes that one can heal from loss and move on.
Grief Triggers
Some of life's circumstances can trigger grief reactions, and a substantial part of the reaction
may be beneath the level of conscious awareness. Bringing those triggers into one's
consciousness helps one to understand where the free-floating sense of anxiety, irritation, or
depressive thoughts might be coming from. The grieving person is no longer unaware of what
fuels negative behavior.
Anniversary Reactions
Anniversary reactions are common on or around the anniversary of a loss or death. One may
feel a vague or even an overwhelming sense of pain related to a loss, a pain that feels as if it
is coming out of nowhere. One may experience the same reaction around the time of previous
significant dates, such as hospitalization, sickness, sobriety, or divorce.
Holiday Reactions
Holidays often stimulate pain from previous losses. Because holidays are traditional ritual
gatherings, they heighten our awareness of what is missing or what has changed.
Age-Correspondence Reactions
This reaction occurs when, for example, a person reaches the age at which someone with
whom he or she identified experienced a loss. A daughter whose mother divorced around age
45 may find herself thinking about or even considering divorce when she reaches that
approximate age.
Seasonal Reactions
Change of seasons can stimulate grief or be unconsciously associated with a loss, thus
causing a type of depression during a particular season.
Music-Stimulated Grief
Music can act as a doorway to the unconscious. It activates the right brain, drawing out
associations and feelings that get stimulated by a particular song or music.
Ritual-Stimulated Grief
Important shared rituals can stimulate grief when there has been a loss. For example, family
dinners or Sunday brunch can be a sad time for family members who have experienced
divorce.
Smells or Returning to a Particular Location
Smells are among with one's earliest memories, and reexperiencing them can stimulate
memories associated with those odors. Visiting a place that one previously shared with a lost
loved one can bring painful recollections and, if feelings are confronted honestly and directly,
eventually mastery.
Inadequate Attempts at Dealing With Grief
Some attempts to deal with or manage grief do not necessarily lead to satisfactory resolution
and integration. Those inadequate attempts include the following types of resolution:
* Premature resolution occurs when people try to force themselves to resolve grief without
allowing themselves to move through the full cycle of mourning. In those cases, the
unresolved feelings tend to come out sideways in the form of projections, transferences,
bursts of anger, simmering resentments, excessive criticism, bouts of depression, and so on.
* Pseudoresolution is a false resolution that occurs when a person fools himself or herself into
feeling that grief has been resolved, when actually it has not run its course.
* Replacement is when a person replaces the lost person or circumstance without first
mourning that loss. For example, the divorced person who immediately marries again may
feel he or she has solved the pain of loss when, in fact, the loss has not been processed and
learned from. In the case of divorce, the same issues that led to one loss tend to reappear in
the next relationship.
* Displacement occurs when mourners cannot connect their pain to what is actually causing it
and instead displace the grief, upset, anger, and sadness onto something or someone else,
thereby displacing the pain to where it does not belong. It becomes difficult to resolve the
grief because it is projected onto and experienced around the wrong subject. Grief needs to
be consciously linked back to what is actually causing it.