I have been employed in an inpatient chemical dependency treatment center in Upstate New York since 1986. One of the many issues that chemically dependent individuals deal with is loss. There are losses specifically related to their drug use (i.e. jobs, friendships, family) and losses related to death.
For chemically dependent individuals, their adjustment to loss is complicated by their lack of sober coping and socialization skills. They typically deal with their emotional pain by self medicating with alcohol and/or illegal drugs. Individuals who eventually make choices to become drug-free will experience a delayed intense reaction to loss because they no longer have their drug of choice with which to self medicate.
In October 2003, seven months after my daughter Jeannine died, one of my co-workers referred a female patient to me for grief counseling. I will use a fictitious name for confidentiality purposes. Jenna was a 47-year-old divorced female with a long history of cocaine dependence, depression and anxiety. She also had previous treatment for chemical dependency, with her longest period of sobriety being eight months. Her son Robert, age 17 had died in a car accident about four years prior to her current treatment episode.
During our first interview, Jenna told me that she self medicated her emotional pain with cocaine on a daily basis from the time that her son died until she made a decision to seek treatment. She also indicated that she was currently having nightmares about her son’s death and having difficulty sleeping at night. She also complained of being “out of it” and not having energy or the ability to concentrate.
As a bereaved parent, I identified with her physical, emotional and cognitive reactions resulting from the death of Robert, because I experienced them after Jeannine died. The first thing that I did was to attempt to normalize her behaviors in the context of the grief response while asking her questions about Robert. I also pointed out that without access to drugs to self medicate, that she was experiencing Robert’s death as if it occurred in October of 2003 and not four years earlier.
Jenna seemed to be relieved that she wasn’t going crazy, and told me that she felt like I fully understood her experience. Prior to Jeannine’s death, I might have tried to offer solutions to Jenna’s grief. As I discovered from my own experience, there are no solutions.
Jenna’s progress was discussed at a treatment team meeting shortly thereafter. The ultimate goal of these meetings is to incorporate input from everyone present to develop the best possible treatment for chemically dependent individuals and to discuss behavioral issues that may be having a negative impact on their treatment experience. Staff brought up their concerns about Jenna not consistently attending scheduled activities and groups, her mood and general motivation for treatment.
I explained that the behaviors that we were seeing were normal responses to the devastating loss of her son four years earlier, and were not a reflection of her lack of motivation. I suggested that we work as a team to help her develop the necessary coping skills to grieve her loss and help her adjust to her new reality. I also suggested that we not push her to attend groups if she did not have the energy and instead help her develop alternative plans to meet her needs. In time, Jenna demonstrated significant progress and successfully completed treatment. About six months after she completed treatment, Jenna wrote to tell us that she was clean and sober and to thank us for our help.
The following points and interventions should be considered by helping professionals when addressing grief and loss issues with chemically dependent individuals:
- Create a safe, non-judgmental environment for grief and loss to be expressed.
- Focus on listening and allowing them to talk about the significance of their losses.
- Encourage them to find their own individualized ways to grieve. Some prefer to journal, others will express their grief through music, art or poetry.
- That chemically dependent people are resilient and have strengths that can help them in their grief journey. Have them identify those strengths and celebrate them!
- Teach the proper social skills to help them utilize self help groups. These skills may range from engaging in small talk with their peers to asking for help from others individually or in a group setting. Their ability to master these skills will ensure that they will receive maximum benefit from self help groups.
- Assist them in finding a bereavement support group that will meet their individual needs.
- Obtain training in grief and trauma issues. If you do not have that expertise, refer them to a professional who does.