Grief and Addiction

Considering Loss in the Recovery Process

Julie Bates-Maves

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9780429886324
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

Grief and Addiction illuminates the role of grief work in addiction counseling, encouraging counselors to be more comprehensive in their treatment and to increase empathy for what the treatment process is asking of clients.

Acknowledging that entering recovery includes a loss of coping skills, and that it requires building a new identity, this book focuses on addiction-specific grief work. Grief and Addiction integrates concepts like complicated grief, nonfinite loss, trauma, family grief responses, and treatment suggestions in one place—all with a focus on the application to addiction work.

Featuring appendices with information and examples for clinicians, Grief and Addiction provides treatment strategies drawn from both the addiction and grief world for professionals and counselor educators.

Part I
Setting the Stage

1 Introduction

Intent

As a counselor and now a counselor educator, I am fascinated by clients’ stories and the ability of humans to withstand great pain. More than that, it’s the ability to endure great pain and still keep moving that catches my attention. Addiction is not simple, and yet we often simplify the narrative; that is, addiction is often equated to being stuck, moving backwards, and/or the erosion of a life. I have worked with many clients who would agree that for them, addiction meant just that—being stuck, becoming a different person, losing sight of the larger world, and sometimes even death. Yet, many of the same clients also described relief and/or the added ability to cope (or avoid) intense emotions or circumstances through use or other behaviors. Still others described addiction as offering a distraction, optional numbness, perceived action against problems, community or a sense of belonging, a sense of control or identity, and/or physical relief; in short, a way to sustain and cope with life—even if it was a crappy life. Other clients described enhanced creativity or social prowess, a sense of power (over self and others), and feelings of security or certainty. For others, addiction added deceit, abuse, trauma, self-deception, fear, pain, and strained or failed relationships. Ultimately, I have found that in many stories, addiction added to life as much as it took away.

Addiction is about both presence and absence. In considering how to help people end an addiction, we need to consider the whole picture of what the behaviors brought, produced, or were intended to produce (the presence) and what they took away or diminished (the absence). An examination of the elements that were purposeful and functional and those that eroded purpose and ability. In the larger world (particularly in popular media) and sometimes even in the counseling relationship, addiction is framed as something that’s only killing you, rather than something that’s helping you survive. I believe addiction is both—it’s running toward and away from death at the same time. The irony never escapes me that counselors so often combat all-or-nothing thinking, and yet we sometimes engage in it ourselves when working with clients.

When faced with severe consequences, especially death, humans can search for a solution before they search for understanding. That urge is understandable and one I certainly experience myself—I want to fix something that seems broken so there is less pain (for me and others). Yet, my training and professional understanding tell me that simple fixes may do no better than a band-aid over a gaping wound. They provide the appearance of protection or action but offer no actual healing.

To treat and heal our wounds, we need to examine them to determine the damage that’s been done, clean them and stabilize our body, take medication if needed, and give our body time to sort things out so that we recover. Last, we need to assess how we were hurt in the first place to avoid the same injury in the future. I see addictions treatment following a similar path.

We need to examine what’s inside the addiction, determine the damage that’s been done (as well as what’s still intact), stabilize the body and the mind, medicate if needed, and allow the body and mind time to adjust, and sometimes acquire a different level of functioning. At times, we deal with scars that are left—lasting effects of a deep wound. My goal with this text is to further explore the so-called wounds of addiction and to discuss some options for beginning to heal them. As stated earlier, grief and the grieving process will play a central role, as well as examining the impact of loss and the opportunity for reconstruction of meaning.

When clients enter recovery, some begin to grieve what was lost during the addiction and celebrate the beginning of sobriety, of recovery. But what about grieving the loss of the addiction itself? In my own clinical work and in speaking to other counseling professionals, I have noted little discomfort or objection to exploring the “negatives” of an addiction with clients. Notably, I have encountered hesitation or overt avoidance of the “positives” of addiction, that is, “don’t speak of the glory days” or “don’t encourage clients to focus on what they miss, instead focus on what they have to look forward to in recovery.”

The more I think about this idea of avoiding the so-called “good stuff” for fear of the session spiraling into a celebration of addiction or complete focus on the past, the more confused I become. Largely the confusion stems from two places:

1. Counselors have skills that are intended to shape and influence the direction and depth of conversations. We need to lean into our skill set to initiate and navigate difficult conversations.
2. What if the “glory days” were the only time the client felt powerful, or noticed, or admired, or skillful? That’s significant. We risk missing meaning when we avoid talking about the perceived high points of use/patterns.

When entering recovery, a client such as this would not only contend with the addition of a new set of behaviors, thoughts, and feelings, but an absence of “glory.” That speaks to identity work, to connection, self-esteem, and potential social skill deficits. Further, inviting reflection on the “glory” of it all is a chance to observe a client reminisce about a time when they felt more worthy. If self-worth is centered on the addiction or a component of it, we need to know so we can help them redefine and reconstruct who they are, not just what they do.

Please note that I am not advocating that addictions are healthy or preferable, but they are purposeful. As stated earlier, for many, addictive behaviors add to life as much as they take away. Addiction and the associated behaviors meet needs and we cannot underestimate how important that is.

As a counselor and counselor educator, I firmly believe in the power of grieving as a healing agent. Examining the meaning of loss and its impact on a life is valuable. Though many counselors acknowledge the importance of grief, it seems that at times, we miss opportunities to broaden concepts and address grief from multiple angles, particularly in addictions. The focus instead can go straight to behavior change and changing a client’s environment. For example, asking or mandating that clients stop use and find a new social group. As healthy as that sounds, both ending use and finding new friends represent major life changes and are inherently filled with loss (and reactions to loss).

This text will emphasize the importance of understanding and processing grief in the context of addiction and recovery. Ideas for how to adapt existing bereavement models to this context will also be included. I sincerely hope that the information presented will encourage counselors to be more comprehensive in their approach and to increase empathy for what the process of treatment is asking of clients; that is to change their internal and external worlds.

Introducing Ben

When I teach, I find that information is more useful when applied to cases. Ben* will serve that purpose here as we move chapter to chapter. This will serve as an introduction to Ben’s story; it will be continued throughout the book as we cover additional concepts.

*Name and details have been altered to maintain client anonymity; case examples are designed for learning purposes and application of concepts.

Ben was a 34-year-old male who identified as Hispanic. He was seeking treatment to end his use of both heroin and cocaine. This was his fourth attempt at recovery; he had tried twice on his own and attended court-mandated outpatient treatment once. His demeanor was quiet and calm. What struck me upon meeting him was how tall he was, and yet, he felt so small. He was bent at the waist, his shoulders were forward, and he had his arms wrapped around his upper body. He looked at the floor with occasional fleeting eye contact and he spoke softly.

Metaphorically, he reminded me of an armadillo. As odd as that might sound, consider this: the outer shells of armadillos project a tough appearance to outsiders, and yet their belly is soft and vulnerable to attack. To counter this vulnerability when faced with a threat, armadillos will first stand still and see if the threat simply passes them by. If that doesn’t work, they run and attempt to hide. If that still doesn’t work, they roll up into a ball and protect themselves; they fold in half and essentially assume the fetal position. They are trying to minimize the damage of an attack by protecting their insides (Conger, 2008). This was Ben. During that first encounter, it was like he was trying to shrink himself to take up less space in the world. Like he was protecting his insides by curling up to buffer any attack he might encounter.

Ben had a 16-year history with heroin and a three-year history with cocaine; this amounts to him initiating heroin use at 18, and cocaine at 31. He primarily injected both substances intravenously and made it clear that this was a complication he ran into in previous quit attempts; he reported “missing” the needle and being drawn to that method of use. He briefly described the “mesmerizing” visual of drawing the plunger back and seeing blood swirl in the barrel. This allure will be discussed in more depth in a later chapter. At the beginning of our work, he was using cocaine and heroin each between three and five times a day.

His initial heroin use came after a football injury during his senior year in high school. His dad injected him with heroin after a severe knee injury and subsequent surgery. Ben said, probably three or so times throughout our first meeting, that the medications were not adequate for his level of pain and “my dad was trying to help me.” He described his dad’s “dedication and support” while growing up and recalled his first experience with heroin.

He would come to every practice, every game. He wasn’t one of those parents who forced their kids … he wanted it [football] because I wanted it. I never doubted he’d be there; he never gave me reason to doubt.

When asked about his thoughts on his dad’s solution to his pain, namely heroin, he said,

At the time, I didn’t even know what it was really. He didn’t tell me it was heroin until I asked for another dose and he didn’t have any more. I trusted my dad and so when he told me, it seemed weird, but I honestly didn’t think too much about it. We never talked about it after that. Years after my accident I learned that we didn’t have good insurance when I got hurt and that my dad had to pay off about $7000 for my surgery. That’s why I didn’t go back to the doctor for my pain; my dad didn’t think he could afford it.

Ben grew up without a second parent. His birth mother did not want children and when she became pregnant, she told Ben’s dad that she would carry the baby to term but “after that, he’s all yours. I’m not meant to be a mother.” As I listened to him, I felt a sadness for him and was curious about his reactions to this. He appeared rather flat and matter of fact while describing his mom and that didn’t really change upon further discussion. Ultimately, he said,

She didn’t really want a kid. I don’t think it was personal—she didn’t know who I’d become or anything. Thinking about it doesn’t really feel good, but she’s never been there for me, so kind of just had to move on, I guess.

Overall, Ben’s basic needs were largely met growing up and he had fond memories of his youth.

We had what we needed and sometimes what we wanted. My dad never really told me how much money we had or didn’t have, and I never thought to ask really. My dad did good most of the time; I know he loved me.

Listening to Ben describe his parents and initial use led me to believe several things about him: (1) He believed himself worthy of love and felt love from his dad; (2) He believed himself capable of loving another; (3) He trusted his father and saw the positives in him even when his behavior was questionable; (4) He was dedicated to preserving his father’s memory and did not want his struggle to reflect poorly on his dad.

At age 18, Ben moved out to attend a trade school for welding. He moved into an apartment with a friend and started using heroin periodically (appr...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgments
• Part I Setting the Stage
• Part II Models and Theories of Grief and Loss and Considerations for Addiction and Recovery: Introduction and Background
• Part III Resilience and Wellness
• Appendix A: Adult Attachment Style Descriptions
• Appendix B: Expanding the Emotional Conversation Activity
• Appendix C: Letter Writing Activity and Examples
• Epilogue
• Index