Addiction and Complicated Grief
Grief is one reason why people turn to drugs and alcohol, and those who suffer from a serious bereavement-related condition called complicated grief may be especially at risk for chemical dependency. Trapped by grief, people with this condition will do anything to free themselves, but drugs and alcohol will only make things worse. Treatment for a dual diagnosis of addiction and complicated grief can be effective, if sufferers are motivated and determined to regain control of their emotions and their lives.
What Is Addiction and Complicated Grief?
Losing a loved one causes deep and enduring emotional devastation. Whether the loss is a spouse, parent, child, sibling, or close friend, the feelings of grief can be so intense it can dominate daily reality.
Despite the depth of their pain, at some point most grief sufferers will recover. Their memories may be bittersweet and their sense of loss may never completely disappear, but that shouldn’t prevent them from re-engaging with the world and reconnecting with their remaining friends and family.
But some people cannot seem to get over their grief. It becomes their prison, and as time passes their pain gets worse rather than better. They remain trapped in the grief stage, unable to move on or forget, and when this happens they may be suffering from a condition called complicated grief (also known as complicated bereavement disorder).
Too often, people suffering from complicated grief seek an escape route from the pain in drugs and alcohol, which can numb their feelings for a little while. But complicated grief is a condition that requires intensive, long-term therapy to overcome, and addiction is the likely result for any grief sufferer who chooses substance use over mental health counseling.
Types of Grief
Grief is a universal emotion in the face of sudden loss or separation. Its symptoms can manifest in numerous ways, making it one of the more complex feelings people experience.
In addition to complicated grief, other forms of grief include:
- Normal grief. Emotions are intense and all-encompassing in the beginning but fade over time.
- Chronic grief. The sense of loss remains indefinitely but does not usually develop into a disabling mental health problem on a par with complicated bereavement disorder.
- Anticipatory grief. Sometimes, grief can set in before someone with a terminal condition passes away.
- Exaggerated grief. Sufferers show intense angst during episodes of exaggerated grief, which usually aren’t long lasting.
- Cumulative grief. When more than one loss is experienced in a short period of time, the feelings of grief blend together.
- Delayed grief. It can take some people weeks or months to truly feel the loss, or move past denial.
- Inhibited grief. People suppress their feelings, denying the true depth of their suffering to themselves as well as to others.
Facts and Statistics
Approximately 20 million Americans will suffer from an ongoing substance abuse problem in any given year, and about 40 percent of this group will also experience the symptoms of one or more mental health disorders. Exact rates of addiction among complicated grief sufferers are undetermined, but there is little doubt they are higher than for the general population.
Complicated grief statistics reveal this is not a small concern:
- Up to 20 percent of those who experience a close, personal loss will develop complicated bereavement disorder.
- About 2.5 million people die in the United States each year, and they will leave behind at least one million new complicated grief sufferers.
Symptoms and Diagnosis of Addiction and Complicated Grief
Grief is not a mental health disorder, but complicated grief is every bit as debilitating as major depression or PTSD, two conditions that it somewhat resembles. Unbearable sadness and vulnerability to triggers that bring the grief into sharper and more devastating focus are signs of complicated bereavement disorder, as are other symptoms that grow out of these painful and difficult-to-escape emotions.
- Some of the common symptoms of complicated grief include:
- Constant focus on the departed person, to the point where it distracts from everything else
- Feelings of unreality, detachment, and alienation from the world
- Inability to take pleasure in formerly enjoyable activities
- Living in the past, and in memories, rather than in the here and now
- Intrusive thoughts about the lost loved one that interfere with normal activities
- Desperate avoidance of reminders of the departed person; or conversely, wallowing in such reminders
- Neglect of daily responsibilities related to work, school, finances, parenting, or relationships
- Feelings that life is empty and meaningless
- Reclusiveness, withdrawal from social life
- Suspicion and mistrust of others, especially when they try to distract the grieving person from their sense of loss
- Thoughts of suicide or suicide attempts
Given the intensity and inescapability of complicated grief, the lure of drugs and alcohol is obvious. Signs that substance use has transitioned into substance abuse and addiction include:
- High levels of drug or alcohol use, despite intentions to use less
- Multiple failed attempts to quit drinking or taking drugs
- Growing tolerance for these intoxicants, accompanied by increased consumption
- Secretive behavior meant to hide the truth about substance use from loved ones or employers
- Suffering physical or mental health effects related to heavy drinking, but still being unable to stop
- Encounters with law enforcement related to substance abuse (DUIs, arrests for disorderly conduct, etc.)
- Trips to the doctor or the emergency room for treatment related to overdose, accidents, or other problems caused by drug or alcohol use
Complicated grief is not currently recognized as a true mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). But mental health professionals may still diagnose it, if several symptoms have been in evidence for more than a month and if they relate to a death that occurred more than six months in the past.
Meanwhile, an alcohol or drug dependency can be diagnosed in the person suffering from complicated bereavement, if two or more of its distinctive symptoms are reported by patients seeking an evaluation.
Dangers of Overdose
When people attempt to escape from their sorrows by overindulging in drugs and alcohol, they run the risk of escaping from everything, on a permanent basis. Over 64,000 people lost their lives to drug overdose in 2016, and another 2,200 died from the toxic effects of too much alcohol consumption.
Common overdose symptoms include:
- Unresponsiveness, an inability to communicate
- Mental confusion
- Extreme drowsiness
- Nausea and vomiting
- Loss of consciousness
Anytime a drug or alcohol overdose is suspected, companions should call 911 to request immediate emergency assistance, and they should let the 911 operator know the exact nature of the emergency so first responders are prepared to offer the proper assistance.
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Causes and Risk Factors for Addiction and Complicated Grief
The direct causes of grief are obvious, but there are extenuating circumstances that make some people more likely to develop complicated bereavement disorder.
The risk factors for complicated grief include:
- Sudden and entirely unexpected deaths
- Two or more losses experienced within a few months
- Past incidences of mood disorders
- High degree of dependency on the person who passed away
- Pessimistic personality traits or approach to life
- Social isolation, a lack of friendships or family connections
- Being somehow responsible for the death
- Surviving the accident or event that took a loved one’s life
Complicated grief is itself a risk factor for drug and alcohol abuse, and those who have a previous history of substance abuse are at high risk for relapse when they lose someone they loved or suffer another type of devastating setback
Additional risk factors for addiction include:
- Currently or previously suffering from any type of mental illness
- Family history of alcoholism and/or drug abuse (genetic and environmental influences are each involved in the creation of this risk factor)
- Exposure to abuse, neglect, or sudden loss of a parent in childhood
Drugs and alcohol are a poor substitute for therapy among those who must deal with overwhelming symptoms of grief, and the sooner they get help the less likely they are to develop a substance use disorder.
Withdrawal and Detox
Drug and alcohol dependency can create a slew of withdrawal symptoms, including anxiety and agitation, shakiness or tremors, insomnia, muscle aches and pains, nausea, headaches, heavy sweating, and racing thoughts that cannot be controlled. At its most extreme withdrawal can cause significant physical complications or disturbing hallucinations or delusions, and for this reason medically-supervised detox is highly recommended as a vital first step for anyone ready to seek treatment for addiction.
During the five-to-10-day detox period, patients will be cared for round-the-clock in a fully staffed medical facility. They may be introduced to medications that can ameliorate the worst symptoms of the withdrawal process, as they make the gradual transition to complete sobriety.
When addiction is present, detox is safe, medically necessarily, and an important precursor to treatment. Recovery is unlikely to last for those who try to get clean and sober on their own.
Research shows that somewhere between one-fifth and one-half of complicated grief sufferers will develop major depression, while somewhere between one-third and one-half will suffer the symptoms of PTSD. These two related conditions produce symptoms that are quite similar to complicated grief, which can make them somewhat difficult for mental health professionals to diagnose and detect when they are present.
Complicated grief produces enormous emotional turmoil and stress, which explains why it is associated with multiple physical health problems, including insomnia, heart disease, cancer, and high blood pressure. Drug and alcohol abuse also makes these problems worse, while damaging immune system functioning in general, and that puts addiction and complicated grief sufferers at severe risk for widespread physical breakdown.
Treatment and Prognosis for Addiction and Complicated Grief
Anyone diagnosed with addiction and complicated grief faces a challenging recovery. Sobriety can be achieved, and complicated grief can be overcome, but healing will require a deep and prolonged immersion in the recovery process.
Ideally, the person suffering from chemical dependency and complicated bereavement disorder will begin treatment in a residential addiction and mental health treatment center, under the care of experienced professionals who understand the complex nature of dual diagnosis recovery. Treatment will consist largely of a daily menu of individual, group, and family therapy, and medication may be prescribed to help patients manage the difficult symptoms of withdrawal and the cravings that can accompany addiction.
Other treatments offered may include holistic healing practices like medication, yoga, massage therapy, wilderness or adventure training, and biofeedback, which are great for stress reduction and the restoration of emotional equilibrium. Patients may also enroll in specialized life skills and coping skills classes that can help grief sufferers learn to manage their emotions, or show people suffering from addiction how to avoid triggers, understand the vulnerabilities that led them to substance abuse, and protect against the ever-present risk of relapse.
Recovery from addiction is a lifelong process, and overcoming complicated grief will not happen overnight. But addiction and complicated grief patients who seek inpatient treatment, and follow up those efforts in continuing care, have an excellent chance of turning their lives around, regaining their health, and restoring their relationships with the people they care about the most.