Addiction and Grief: A Complex Dance

Addiction and grief are woven together like threads in an intricate fabric, shaping lives with their mutual influence on each other. Grief can drive people to self-medicate with substances, often leading to dependency, which in turn activates profound sorrow for both the individual and their loved ones. This profound connection between the diverse forms of grief, and the development and exacerbation of addictive behaviors, results in a painful cycle that can be difficult to break.

Often it starts with ambiguous loss, which is when someone is alive but no longer who they were. Parents may wonder where their sweet little boy has gone, now that he comes home high and holes up in his bedroom ignoring them. The adolescent himself grapples with this same loss as he struggles with his identity, feeling he is so different than his peers. He may be physically or psychologically changing, or his home life or school experience could be stressful. Perhaps there is unresolved trauma from his past. One thing for sure is that he is unable to voice his feelings, and this lack of healthy expression often leads to masking with drugs. Substances dull the emotional pain either by relaxing brain activity, or creating euphoria to conceal the negative feelings.

As a counselor, I have worked for years with parents of those suffering with addiction, witnessing decades of turmoil as their adolescent, young adult, or even older adult children battle their substance use disorder. Depending on the parent’s personality, their own mental health, and things such as culture and stigma, parents can either be very dominant throughout the addiction, and take a “tough love” approach by strictly enforcing consequences for actions, or take a more passive stance. Neither is right or wrong; a parent must do what makes sense to him or her. Sometimes the addiction leads to a devastating death, regardless of parenting style.

Children can die whether their parents are very strong or very gentle. I recall caregivers in my practice whose children died out on the street, thrown out of their homes after their parents had enough of the violence and stealing, embarrassing police calls, and scenes in front of neighbors on front lawns. Others, who have been forced to leave, have not died. Many have hit rock bottom, which finally motivated them to reach out for the help they needed.

Conversely, many parents have coddled their adult children for years by letting them stay close, giving them food, money and a roof over their head. Some of those children died in their own homes, deeply traumatizing their families. Yet hundreds of others have appreciated the help, continued to embrace treatment, and sometimes it works and they flourish.

Family members come to my support groups always speaking about the silent, hidden losses they are experiencing. They report frustration that friends and relatives do not understand their chaos. They see the person’s loved one is alive, not realizing the family has been grieving already for years. Over time this ambiguous grief morphs into what is known as anticipatory grief, as the parent’s fears rise. Imagine what it is like for a parent to creep up the steps to their son or daughter’s bedroom, for the tenth time, haunted by other times they found their child unconscious, and had to revive him or her. Would they find them dead this time?

Those who find their child dead are tormented, grappling with conflicting feelings of relief that the constant worry has ended, yet devastated by the reality that their child is gone. Parents feel responsible for their children’s lives, and thus bear heartbreaking guilt if they were unable to save them.

Just about every group member speaks about the traumatic response they have when the phone rings late at night, or for some, when their child calls at any time of the day. These parents describe high anxiety resulting in physical reactions in their body such as stomach or chest pain, throat tightening up, uncontrollable shaking, and migraines.

Mary, a group member, portrayed anticipatory grief as she feared the impending death of her son. She was always speaking in group about planning her son’s funeral. “I need to pick the songs, the casket, what I am going to say, who will attend, because this helps me prepare for something which will probably happen if he does not get help, and if I am prepared, maybe I will be able to accept it and go on with my life.” It saddened all of us who listened to Mary speak about her son dying, yet we understood her need to face her worst fear.

Addiction is absolutely a disenfranchised grief, which means it is minimized by society. Parents in my support groups reported feeling judged by extended family, friends, neighbors and co-workers. “He chose to take the drug, so he did it to himself,” is something thrown back at these parents by their community. This judgment ignores the pain and sorrow of dealing with a loved one’s addiction.

When parents feel so judged, they tend to isolate, becoming anxious and depressed. Furthermore, parents who lose a child to addiction are sometimes treated very differently by their community when compared to parents who lost a child to other things such as cancer or an accident. Some people have callously stated in mixed support groups that they “do not feel bad” for addiction-related deaths. This is so painful for grieving parents to hear and withstand this criticism.

Marriages can either become stronger when dealing with addiction, or unravel from the pressure. When there is the loss of a child, the pain is too severe for parents grieving to support each other; they require individual help to cope. This is what we call traumatic grief, an intense and incapacitating grief, which can be difficult to process, as it includes overwhelming sorrow and intrusive memories. Traumatic grief permeates through families of addiction, but most profoundly, when someone dies.

Steve and his wife Ellen, for example, fled their town after their only daughter Amanda died of an accidental overdose, overwhelmed with tremendous shame, as they felt they had failed as parents. Shattered by her death, they could not bear to stay in the same area where they no longer identified with other parents who were happily sending their children off to college. Steve spoke about how Amanda’s death forced them into abrupt changes in their life resulting in an immediate loss of community and identity.

Ellen cried hard as she reflected on one friend who told her “If my child died, I would not be able to go on living.” Ellen thought, “Did I not love my child enough because I am still alive?” Both Steve and Ellen describe their loss as “the most horrible event a married couple could face.” They report times where they were so tormented by guilt, they felt they might “go insane.” Steve stated he would feel physically ill, and had suicidal ideation from his pain. Amazingly, this couple has persevered together.

Complicated grief, includes a prolonged grief response involving symptoms that prevent adaptation to the loss, such as constant yearning for a loved one, preoccupation with the loss, and feelings of anger, confusion, and guilt. Josephine, six years out from her son’s death from opiates, is still struggling to find ways to wrap her mind around all that had transpired for the years leading up to his death. Although Josephine was able to set boundaries and ask for what she needed during the time he suffered, in her grief she is not clear, even after six years, as to what she wants from others.

If people do not bring up her son anymore, it stings. Yet she is angry when others state that she should be relieved that the unrest is over. It is complicated, because she would rather have him here with the insanity of life with addiction, rather than gone, even though her life is calm and quiet since he is now at peace.

Josephine’s grief also has affected her health, as she has had autoimmune diseases come out which she feels is related to her grieving. The impact of grief on our physical health is an ongoing discussion between healthcare providers and their patients. One book, which has gained popularity recently for its important knowledge for those grieving, and those treating grief, is Mary Frances O’Connor’s “The Grieving Body,” which highlights how grief affects the body.

Josephine’s struggle exemplifies the broad impact of addiction on families, where the tremendous lack of control affects everyone involved. We always refer to it as a “family disease” because each member plays a role in the dynamic. The person with the addiction feels shame for what they are putting their loved ones through, and the caregivers feel helpless.

Education about the “3 C’s” taught in 12-step recovery programs - they didn’t cause it, they can’t control it, and they can’t cure it, helps families set boundaries and practice self-care. Asking for what they need, gives both the family member and the one trying to recover a voice.

Even without death, there is a plethora of grief work. People unable to recover cannot thrive and be who they want to be in life. This is devastating to witness as parents, and equally difficult to live through it, as the child. Young adults sometimes drop out of their education, lose great jobs, and struggle through relationships which ended from the strain addiction caused.

While families are struggling with addiction, we cannot ignore that as a society, we also are experiencing collective and cumulative grief related to the Opiate Epidemic, and accidental deaths from fentanyl poisoning. Currently prosecutors are going after drug dealers for murder charges, due to lacing their product with fentanyl. It is common that in support groups I will hear a young adult say they have lost multiple friends to overdoses. In collective grief, we share emotional responses to these deaths, and realize the impact on our community. The cumulative nature of this is overpowering, as there have been so many deaths from addiction in a short period of time. The heartbreaking loss of young lives, with so much more potential, begs researchers to seek solutions.

Although treatments will continue to improve, the person drinking or drugging still needs a great deal of support from their family and community. Most cannot get themselves clean without help from people well-versed in addiction. Inexperienced counselors often want to give advice, mistakenly thinking there is a best way to handle addiction. There is not. This judgment does not help families; reinforcing positive behaviors is a better goal to work towards.

It remains clear that addiction and grief are a complex dance. When I see the word addiction, I automatically think “grief.” Addiction is a misguided attempt to veil the intensity of grief, and grief, in turn, can deepen addictive behaviors. Educating the world on this cycle of dependency is a crucial and ongoing journey towards better understanding and healing. There is always more work to be done and voices to be heard. There has been progress over the years in teaching that addiction is a disease, however the stigma addicts and their families feel, is still widespread. We must work towards recovery, while taking into consideration societal changes, such as new substances emerging, cultural pressures, and available mental health resources.