Losing a loved one is traumatic, and it is something that takes time to get over. When grief sets in that is to be expected, and recovery is likely to occur gradually and in stages. Unfortunately, in some instances the recovery process may stall. Six months to a year later, the sense of loss remains powerful and overwhelming, and the person experiencing it finds it impossible to move on.
When grief becomes chronic and symptoms don’t abate, this is known as complicated grief, and while this is not an officially recognized psychiatric disorder it is a still a disabling condition that calls for psychotherapy and other forms of mental health treatment. Complicated grief is not a normal reaction to loss, but an indication that bereavement has taken over a person’s life and left them unable to cope with daily reality.
Under the influence of complicated grief, many people become vulnerable to the lure of drugs and alcohol, which seem to offer the possibility of escape from unbearable emotions. Even with normal grief substance use issues can develop in a short period of time, if the person experiencing the loss turns to drugs or alcohol to numb their pain.
Grief is a normal human emotion. But its ubiquity seems to discourage people from seeking help, even when their grief is profound. Too many people think they should “tough it out” or “just get over it,” which prevents them from getting the counseling they need to overcome the sadness.
Unfortunately, suppressing or denying grief won’t make it go away. In fact, taking that approach will almost assuredly make things worse. Depression may eventually develop alongside the grief, and complicated grief is a common outcome when treatment is delayed.
Men and women struggling with mental health issues, including intense grief, often self-medicate with drugs and alcohol. It would be better to seek professional help, but that’s an option many people refuse to consider. As a result, they choose a path that will only get them into deeper trouble if they don’t reverse course quickly.
Brief experiments with substance use may not be harmful to those suffering from grief, especially if the person realizes the futility of that approach. But if a grieving person continues to drink or use drugs to avoid painful emotions, their behavior may escalate beyond the point of no return.
Chemical dependency can develop in just a few weeks when grief and substance use are mixed, and when addiction develops it may intensify the feelings of grief rather than offering relief. Addiction is accompanied by changes in brain activity that encourage depressed moods, and repeated attempts to self-medicate will only deepen the hold of the complicated grief, or possibly trigger the onset of complicated grief if it hasn’t already developed.
The link between substance abuse and mental illness is well-established. In 2016, 43 percent of people with a substance use disorder also experienced the symptoms of a mental health disorder—and in most instances it was the mental illness that came first, which highlights the risk people grieving face if they decide to drink or use drugs.
Complicated grief (also known as complicated bereavement disorder) is currently listed as a “Condition for Further Study” in the appendix of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). But it is nevertheless a form of psychological and emotional disturbance, and as such it creates a substantially increased risk for substance use disorders, especially if the condition remains untreated. It also boosts the risk for other mental health disorders: studies have revealed that between 20 and 50 percent of people with complicated grief will also develop depression or PTSD, or possibly both—and these conditions also predispose a person to substance use issues.
Each year, 2.5 million Americans die, and they leave behind tens of millions of loved ones who are vulnerable to grief and associated conditions. Approximately 10-20 percent of these people will develop complicated grief, and only a small portion will receive grief counseling.
Grief causes an extraordinary amount of repressed and unacknowledged suffering, and that is why it is strongly associated with drug and alcohol abuse.
Grief is not unhealthy unless it becomes overwhelming and unshakeable. Some of the symptoms of complicated grief (or problematic grief in general) include:
These are symptoms associated with complicated grief and are especially troublesome if they continue for more than six months after the loss. But even in the initial stages of grief, such thoughts and emotions are intensely painful and could put a person at risk for addiction if drinking or drug use occurs. It is never too soon for grief counseling following the death of a loved one, and this type of therapy can be quite effective as a form of preventive medicine.
When substance use escalates, the chances of chemical dependency are high, whether grief is the motivating factor or not. Addiction specialists and other clinicians will diagnose substance use disorders based on the presence of multiple distinctive symptoms, such as a growth in tolerance, the experience of withdrawal symptoms, attempts to quit drinking or using drugs that ended in failure, frequent unplanned overuse of drugs or alcohol, or the continuation of the substance use despite health problems, interpersonal conflicts or other significant life difficulties.
People already struggling with grief who develop chemical dependency may plunge into an irreversible downward spiral, and if there is no intervention the results could be tragic.
Despite the lack of any official status for complicated bereavement disorder, dual diagnosis treatment programs are still available that can help people cope with debilitating grief even as they tackle their drug and alcohol problems.
Grief counseling is a specialized form of therapy, designed to bring peace and acceptance to anyone regardless of the depth and nature of their emotional disquiet. In the hands of a skilled professional, individual therapy for grief is empathic, compassionate and collaborative, and focused on the future in a way that does not deny or suppress the past. Group and family therapy sessions can further the healing process as well, by giving men and women dealing with grief a chance to express themselves in front of others who are prepared to offer unconditional support.
Everyone is entitled to their grief, and open acknowledgement of those feelings is essential to recovery. But no one deserves to be marooned by grief forever; therapists will rely on evidence-based approaches to help their clients come to terms with their sense of loss, as they strive to renew their connection to the world and to their family and friends.
Having a dual diagnosis for complicated grief and substance use creates complex challenges for the person in recovery. But inpatient dual diagnosis treatment programs give people in this situation the time, space and attention they need to address all of their emotional and behavioral symptoms simultaneously.
For people who are ready to move past the pain and regain control of their lives, comprehensive treatment for grief and addiction can produce marvelous, transformative results.