I was employed for thirty years in the Human Services field. For approximately twenty-seven of those years, I worked as an addiction counselor and clinical supervisor in a New York State funded inpatient facility located in Upstate New York. I retired in July of 2012, with absolutely no regrets, to embrace more opportunities to teach at the undergraduate college level, do more bereavement support in my community and pursue other activities of interest to me. Ten years before my retirement in 2002, I became an unintentional student of death, after my 18-year-old daughter Jeannine was diagnosed with cancer and subsequently died on March 1, 2003.
The challenges that I experienced with Jeannine’s death changed the way that I both viewed and addressed grief with those chemically dependent individuals who requested services from me. Prior to my daughter’s death, I inevitably used Elizabeth Kubler Ross’s stages of grief to counsel those who experienced loss due to death. I was exposed to the stage model in my early training I blindly accepted it as the model to use to help grieving chemically dependent people.
I recall one interaction that I had with an individual where I literally pulled out a pamphlet on the stages of grief and explained to him how grief should predictably progress. Today, I cringe slightly when I recall this intervention.
My own experience with my daughter’s death taught me that grief does not progress in a time-limited, straight line path. Besides, I later discovered that research studies did not support the belief that grief progresses in predictable, linear stages.
Working with chemically dependent individuals is challenging without factoring grief and loss into the equation. First and foremost, there are stigmas associated with addiction that may prevent individuals from seeking help or convince them that they are not worthy of help. The person who is addicted is only seen as an addict. The addition represents the individual’s behavior and is not a reflection of the positive qualities that endear him/her to others.
They are smart, passionate, creative and generally good people and fun to be around when they are sober. In fact, many individuals who continue their dance with addiction until death, have had significant periods of sobriety characterized by service to other individuals who are struggling with addiction. If an individual does seek help, it may take him/her more than one treatment presentation to achieve long term sobriety; in fact, it may take several. Because of that I learned patience as a therapist and recognized that one of my roles was to adequately prepare an individual for another treatment presentation if they were in denial about the need to alter their behavior.
Working with grief in chemically dependent clients is challenging, due to the fact that they use drugs, in part, to medicate pain. They may also experience delayed grief soon after becoming drug-free. Delayed grief occurs when the person experiences the intense pain of suppressed loss due to their use of drugs. The intense pain of early grief can and will surface, no matter how much time has passed since they experienced the death of their loved ones.
During my last eight years as an addiction professional, I began to discover similarities in the journeys between chemically dependent individuals who are working to attain sobriety and non-chemically dependent individuals who are trying to adjust to life without their loved ones:
Reliance on Support Groups
Chemically dependent individuals rely on support from such 12 step self-help groups such as Alcoholics Anonymous and Narcotics Anonymous to facilitate a drug-free lifestyle. Regular attendance at these self-help meetings helps them feel less alone and isolated during their recovery journey.
Individuals who have experienced loss attend support groups best suited to meet their needs. So they may attend support groups for suicide or homicide survivors, death of a child, death of a sibling and death of a parent or spouse, either online or in person. For both grieving and chemically dependent individuals, inadequate support networks can be detrimental to their progress. For chemically dependent individuals who have specific grief issues, attendance at a support group specific to their loss is also indicated.
Stories are Important for Personal Growth
The significance of the journeys of both chemically dependent and bereaved individuals is enhanced by the stories that they tell about their addiction and their deceased loved ones. For both groups the stories about their deceased loved ones allow them to come alive through those stories.
For chemically dependent individuals, the stories about how they and the people that have been affected by their addiction allow them to both see the consequences of their actions and help them to envision the path they wish to take to achieve long term sobriety. The stories involving their prolonged periods of abstinence and its positive impact on others allow them to understand that they have strengths that can be assets during times of relapse to drug use.
Emphasis on Self–Care
Individuals who have experienced loss are encouraged to develop their own personal self-care plans, which can include ways that they can nurture themselves physically, psychologically, spiritually and emotionally after loss.
Chemically dependent people are also encouraged to develop self-care plans to include the same elements of a comprehensive self-care plan .However their self-care program also needs to include a specific relapse prevention plan designed to facilitate effective management of their relapse triggers.
The journeys of both the chemically dependent person and bereaved individual are circular rather than linear. A chemically dependent individual may re-experience urges to use at any time in their recovery due to contact with old places, people and things that contributed to their use, or due to stress. Their ability to effectively manage those urges are crucial to sustaining continued sobriety.
For the bereaved, the continuous occurrence of milestone events (e.g., birthdays, death anniversary dates) can result to a return to the intense emotional pain of early grief. Their ability to effectively manage those events are crucial to facilitating eventual acceptance of the fact that their worlds have truly changed after loss.
When cognizant of the similarities in the journeys of grieving individuals and chemically dependent people, human service professionals can become more empathetic and compassionate witnesses to their challenges and the revelations that unfold as a result of them.
I do not ask the wounded person how he feels, I myself become the wounded person.— Walt Whitman- Song of Myself