Grief work with substance abusers

Coping Strategies and Complicated Grief in a Substance Use Disorder Sample

Background: Previous research has identified a link between the loss of a significant person, grief complications, and substance abuse. People with substance use disorder (SUD) are more vulnerable to complicated grieving symptoms following loss. From sociocognitive theories, the model of coping with stress assumes that substance use is one of the responses used to cope with traumatic life events. The main objective of this study is to identify the coping strategies of people with SUD and to analyze their relationship to complicated grief (CG).

Methods: A sample of 196 bereaved drug-dependent patients was assessed, after providing written consent, in sociodemographic variables, drug and bereavement related characteristics, CG symptomatology (Inventory of Complicated Grief) and coping strategies (Coping Strategies Inventory).

Results: There are differences in relation to the coping strategies used among patients with CG, using more those focused on emotional expression, social withdrawal, wishful thinking, and self-criticism.

Conclusion: We can conclude that, in general, CG in patients with SUD is more associated with the use of less adaptive coping strategies. This data can contribute to a better understanding of the different variables involved in the grieving process among people with SUD. It is important to point out the clinical implications of addressing what the coping strategies associated with improved grief outcomes among people with addiction problems are.

The relationship between substance misuse and complicated grief: A systematic review

Complicated grief is a prolonged, bereavement-specific disorder with significant psychological and physical consequences. Although complicated grief represents a risk to individuals with substance misuse, this relationship is poorly understood. Consequently, this systematic literature review examined empirical findings regarding the relationship between substance misuse and complicated grief. We searched 11 databases to identify pertinent quantitative studies published in English. Our search yielded 12 peer-reviewed journal articles (N = 1749) published between 1997 and 2017. Included studies evaluated the prevalence, assessment, etiology, correlates, risk factors, and treatment of complicated grief and substance misuse among individuals with one or both conditions. Our review found evidence of a positive relationship between complicated grief and substance misuse. Individuals with substance misuse were at increased risk for subsequent development of complicated grief, particularly when increases in substance consumption preceded bereavement. Conversely, complicated grief predicted increases in smoking and alcohol dependence. Multiple risk factors for individuals with complicated grief and substance misuse were identified and discussed. An existing complicated grief assessment performed well among individuals with substance misuse, and grief interventions were effective in reducing symptoms of complicated grief and substance misuse simultaneously. Given the severity of consequences associated with both conditions, more research is needed to understand this relationship, identify effective assessment tools, and evaluate intervention strategies to improve outcomes.

Evaluation of a Grief Group for Women in Residential Substance Abuse Treatment

Most women in substance abuse treatment have experienced significant losses. This preliminary study examined the effectiveness of a therapy group addressing grief and loss among women enrolled in a gender-specific residential substance abuse treatment program. The intervention group consisted of 24 grief group participants and the comparison group consisted of 31 nonparticipants. Qualitative analysis revealed a pattern: participants identified traumatic loss, moved to emotional loss and abandonment by their own mothers, then focused on their own children. Data obtained at induction and at exit or follow-up were used for quantitative analysis. Length of stay, self-esteem, depression, mood, and parenting attitudes were assessed using standardized instruments. Women who participated in the grief group remained in treatment longer. While both groups were depressed and had low self-esteem at induction, the self-esteem of nonparticipants was significantly lower than that of participants. Both groups improved over time on mood, depression, and parenting. At exit or follow-up, participants had higher self-esteem. Based on these findings, we hypothesized that higher self-esteem at induction made it possible for women to participate in and benefit from the grief group, thus contributing to length of stay. To test this hypothesis we conducted regression analyses which found that, individually, group status (participation) and self-esteem explained 11% of the variance in length of stay. However, since the number of women with available data varied for group status and self-esteem, group status was a significant predictor of length of stay and self-esteem showed only a trend toward significance. These findings support our hypothesis. The women's pattern of disclosure and the hypotheses drawn from the results of this preliminary analysis will be examined further in an evaluation of a series of groups focused on loss and grief.

Loss-grief addiction model

This group study features a loss-grief inventory in the treatment of ninety-eight substance abusers in a public outpatient treatment facility. The inventory serves as both assessment and treatment tools. That is, the inventory helps the counselor and the client to identify unresolved loss-grief issues which may contribute to the addiction; it also serves as a treatment tool to assist the client through the grieving process. In identifying losses, the client has three time categories from which to choose: 1) pre-addiction losses; 2) losses associated with the addiction; and 3) losses associated with entering treatment. An additional feature of the inventory illustrates a simplified procedure to compute the client's unresolved loss-grief level through use of a 5-point Likert scale.

To surrender drugs: a grief process in its own right

The basic thesis of this article is that addictive substances, because of their need-grafifying and self-medication value, become so central to the life of the addicted person that their absence is associated with a grief reaction. Painful feelings of loss and helplessness accompany drug surrender. This view contrasts with formulations that indicate that mourning experiences observed in recovering persons are specific to and determined by unresolved past losses of loved ones. The author discusses the theoretical underpinnings of the drug-loss grief reaction. Also presented are case vignettes that demonstrate the grief aspects of drug surrender. Finally, the role of brief psychotherapy as a vehicle for helping clients cope with their grief reactions is discussed.

The effects of comprehensive inpatient alcoholism treatment on measures of loss and grief

Current research has identified a grief reaction in alcoholics undergoing inpatient treatment. The addition of a loss/grief experience to an existing comprehensive treatment regimen is examined to determine its ability to enhance loss/grief awareness in an experimental group of patients. Loss identification and grief awareness measures for this group are compared with like measures for a group undergoing the regular treatment program. No significant difference between the groups is reported. It is proposed that existing models of comprehensive treatment increase loss awareness and initiate a grieving process without the addition of a specialized treatment component dealing with loss and grief.