Tag: #addiction

Grief Meets Stigma

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Grief is difficult enough when your relationship with your loved one was generally healthy, you had a chance to say goodbye, make amends, or just say ‘I love you’ one last time. The pain of it is overwhelming; at times, unmanageable. 

When you add stigma to the experience of grieving it makes makes it exponentially more difficult to manage. 

Stigma can simply be defined as being ‘othered,’ or viewed negatively by people, systems, or organizations and is manifested in overt behaviors or subtle language. The stigmatization can be formalized for example, only given two days of bereavement time after the death of a spouse or parent or terminated from a job. Or informally expressed in language used by those who might think they are being supportive. 

Stigmatization of grief often results in disenfranchised grief which proceeds hand-in-hand with complicated grief; known to increase symptoms of depression, mental health illnesses, alcohol and/or substance use, as well as impact physical health, ability to perform at work and overall life satisfaction. 

Grief can be a tsunami in someone’s life and if they do not feel that they can reach out for help from people, organizations or systems then that will almost always worsen the impact of grief. 

Stigmatization affects people inwardly and outwardly.  It can translate into the inability to attend funeral services or have acknowledgment of the importance of that person in your life. For example, one member of a gay couple dies and the family does not want it known that their child was gay so introduces the partner as a “friend” or ignores the partner completely. 

Or a child or sibling dies from a drug overdose the parents or family might blame the child’s partner for the overdose (particularly if both had a history of use). If the couple lived together in the deceased house/apartment the family might refuse to allow the partner to take any remembrance, or have any of the ashes (if they are cremated) or even have access to the home to retrieve their own possessions. They might take possession over animals that were shared. 

A partner in an affair who loses their lover but who cannot outwardly grieve. Cannot attend any of the services, and might have difficulty explaining to people why they are unable to be part of the communal rituals. 

Stigmatized grief, disenfranchised grief and complicated grief are all difficulties often endured by those who are addicted to substances or are working towards their recovery. The opioid epidemic has created a grief epidemic that is mostly born by stigmatized people. The addict, the substance user, the one struggling in their sobriety needs a space to grieve their losses. And in the opioid epidemic the losses continue to rise. 

If one person you cared about died every year for 5 years it would be overwhelming; almost impossible to recover from. Imagine if almost every death was stigmatized — they were using drugs, opiates, heroin, fentanyl — ‘it was bound to happen.’ Imagine if every death was one you couldn’t share with family or friends because they would point to your own struggle with substances, maybe your own continued use of opiates. 

My goal is to give those struggling with addiction the safe place to talk about their grief and how it is affected by their addiction. In the next couple of months me and a colleague of mine will be starting a drop-in grief group in Niagara Falls, NY for those in addiction or in recovery from addiction in order to give them a safe and supportive space to process their grief. 

Grief Meets the Village

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It takes a village to do just about anything. To raise a child. To move. To deal with the death of a loved one. To defeat addiction. 

Oftentimes those villagers are other people who are in the same boat, so to speak. They are also struggling with substance use, the death of a loved one, or in the trenches with a toddler who loves the word no. 

But sometimes, those villagers need to be professionals. Sometimes we need a village of professionals to help that person defeat their addiction, or grieve a loved one. 

Here’s a little story to set the scene for our village. 

Let’s say that Tonya and Jake are in love. Both are in recovery. Jake has almost a year sober from opioids; Tonya has a year and a half from the same. They are both working good jobs and have bright futures. They go to treatment or NA meetings regularly. They have supportive and sober friends and family members. They want to get married. They want to have a family. Both have lost friends to this addiction and vow to never touch opioids again. 

But then, Tonya relapses. Jake finds her in the apartment they’ve just begun to share. She’s overdosed and no one was with her to revive her. They had Narcan in the apartment; on the refrigerator, in plain view. 

Jake is devastated and ends up using himself. He overdoses and is revived by a friend who has Narcan too. Tonya’s family, once loving now blames Jake. They won’t let him into the apartment to retrieve his things, they won’t let him have any memento of Tonya’s. There is a huge fight at the funeral and he leaves. **

**Composite case. All names/identifying information has been changed.

What professional villagers might be able to help Jake? Or what villagers are needed to help diffuse situations like this? Or, even, what professional villagers might be needed to prevent this from happening? 

Jake’s substance use team is on the front line (counselor, MAT provider, psychiatrist). They recognize Jake’s increased risk for relapse and overdose and get him into the clinic. But Jake needs to keep his job. He works late and can only get in once or twice a week. He tries to go to meetings. He needs different kinds of villagers to help him out. 

What does he need exactly? Our goal? Keep Jake alive. Help him grieve Tonya and eventually, when he’s able, move on in his life. 

If he had a recovery coach? Or a case manager who could check on him, meeting him out in the community? If he had a grief group to attend, one that specializes in losses from addiction when you are in addiction.  

Anyone is welcome in an open, general group, but is someone who struggles from substance use, who lost their friend, sister, lover, to overdose going to feel comfortable sharing there? Maybe? But how do you process the shame and fear and devastation of the loss when the others in the room might not know what it is to lose someone like that? 

Medical professions are other important people in this village. ER professionals see those struggling from substance use frequently. Could an overdose be an opportunity to check in with them? Not just stabilize their medical symptoms and send them back out.  What happened? Is anything going on in your life that might have led to the relapse or overdose? I’m not suggesting these are intentional overdoses (although some might be). I’m suggesting it’s an open door to check on the psychosocial well-being of someone in addiction. 

So how can these ODs be prevented to begin with? How many different kinds of villagers do we need? 

We sure need researchers to continue to answer the questions that might help guide treatment. We need sociologists, psychologists, and neurobiologists. We need technology inventors, computer scientists working in Big Data and artificial intelligence to develop technologies that will continue to help providers and clients do more with less. We need public relationships gurus who are willing to take on stigma and figure out a way to get rid of it. 

We need a way to help Tonya not relapse at all. But if she does, and what happened, happens, we need to figure out a way to help all of those touched by Tonya’s death, especially those who have addiction problems, continue to live. 

I’ll leave you with one other thought. What if Tonya had a child? We’d need a much bigger village both before she overdosed and after. 

Grief Meets Peer Support

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Peer support can be a foundation in the recovery process from substance use and in processing grief after the death of a loved one. In-person (Griefshare has a directory of local groups) and online grief groups (see last week’s blogt for a listing) can offer peer support. Those in addiction often rely on support groups like Alcoholic Anonymous (AA), Narcotics Anonymous (NA), Secular Organizations for Sobriety, Rational Recovery, among others, which are led by those in addiction for those in addiction. AA and NA usually recommend those in the program choose a sponsor who is a peer. 

I have yet to find something that combines the two: a grief group for those who are in addiction who have lost a loved one to addiction. 

Generally speaking, there is less stigma in the death of a loved one who died from cancer or a car accident than there is for those who died by unintentional overdose, or a heart attack after cocaine use, or cirrhosis of the liver from alcoholism. Whether the stigma is internal or external, it often exists. And I believe that stigma can prevent people from attending a general grief group. They aren’t sure what the reaction is going to be when they share to the group that they used with their friend/relative/significant other who died. How would someone react? Would they blame them? And if they already feel guilty and ashamed, will it be intensified? Will the group make the grief worse? 

And yet this population needs a place to process their grief as well as a place to share their happy memories. They need a safe place and support to talk it out. Just like all of us do. 

Some studies have shown a connection between grief and addiction, that grief can be a risk factor for use or relapse. Disenfranchised grief, complicated grief and traumatic grief are all forms that sometimes need outside help either in the form of peer support or counseling to reduce its effects. If there is no help or support for this population, does it increase relapse? Could it increase the chances of the griever overdosing and dying themselves? I do not know. So far, I have not been able to find studies that have looked at overdoses that could be connected to the death of a loved one by substance use. 

I’ve found a study that states community support does not positively affect outcomes in grief; and I’ve found the opposite outcome in another study. I have heard from people who attend grief groups say that grieving with others is helpful and takes a bit of the burden off it. They say it helps to share. I’ve heard others say it doesn’t help them; that hearing others sad stories just makes it harder for them. 

The combination of addiction and grief is a difficult one. In order to move through grief it takes the development of tolerance for sadness and emotional pain. And it takes time — a lot of time. Often, someone with a substance use addiction struggles with management of emotional pain. The drug numbs the pain instantly and sometimes they get used to numbing the pain. It makes it difficult to process grief. 

Now, add to that the overwhelming number of deaths related to drugs, and then add “typical deaths” (i.e., illness or accident). 

How does the person with a substance use problem process their grief unless it’s with others who are also struggling with the same issues. What about the girlfriend of the man who died by opiate OD, who is shunned by his family and they blame her for his death. Or the man who used together with his girlfriend and he woke up, but she did not. The man who was drunk by his mother’s bedside and left right before she died to drink some more. The woman who was high at her step-father’s funeral because she couldn’t handle it any other way. 

They are unlikely to walk into a general grief group and with such a disenfranchised grief, a group is one of the things they might need. 

Currently, me and a counselor I work with are working on setting up a drop in grief group for those who are struggling with addiction. I’m not sure what, if anything it will do, but it’s a drop in the bucket and we’ve got to start somewhere. 

Welcome to Grief Meets

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Why is it important to talk about the connection between grief and addiction? Grief can make sobriety harder. And addiction can make grief feel impossible. Researchers have shown that grief after the death of a loved one can increase someone’s risk for addiction, substance or alcohol use, or relapse. 

Photo credit: Mike Labrum

The pain of grief can be immense and people often try to find things that will numb that pain; sometimes that is alcohol or other substances. And if someone is already at risk for addiction, or has a history of alcohol or substance use, avoiding grief can turn into a cycle of use, guilt, and pain. And that makes sobriety, or even reducing use, very difficult.  

I was high at my mother’s funeral. I just never dealt with it.

Grief is both unique and ubiquitous. Everyone will experience it at one point in their life; and everyone’s grief journey is different. Research about grief and how it affects people, spans a century, and researchers and clinicians continue to try to find ways to help people deal with the pain and aftermath of losing a loved one. 

Much of grief research looks at grieving the loss of one person. Those who are touched by addiction experience, especially within the opioid crisis, know many more losses than that. 

They used together but one woke up and the other one didn’t.

The higher number of deaths, closer together, that someone experiences, the more likely that complicated grief, or even traumatic grief, can develop. Add to that months or years of grief distorted by continued use and it’s a recipe for depression, anxiety, guilt and possibly symptoms of posttraumatic stress disorder. 

Over the last 2 years I know 12 people who have died from overdoses.

Grieving takes time. It takes effort and patience in order to develop tolerance to the pain of grief. And recovery takes time. It takes skills and support. Doing both together can be exponentially more difficult. 

Add to that a sense of “nope, I don’t do funerals; I don’t do grief.” If you know that grief can increase someone’s risk of relapse or addiction, it’s important to grieve, right? 

And how exactly do you do that? As a friend or family member or, as a clinician? That’s what this blog is going to be exploring. We’re going to be looking at grief and how it is affected by addiction as well as how addiction is affected by grief — among other things that might make grieving harder. 

  • References:
  • Masferrer, L., Garre-Olmo, J. & Caparrós, B. (2017) Is complicated grief a risk factor for substance use? A comparison of substance-users and normative grievers. Addiction Research & Theory. Vol. 25 No. 5 361-367
  • Mercer, D.L. & Evan, J.M. (2006) The impact of multiple losses on the grieving process: An exploratory study. Journal of Loss and Trauma 11:219-227