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Grief & Loss in
Addiction & Recovery

    Theory, Personal Awareness,
   Grief Reactions, & What Helps
Overview
   Why Talk About Grief?
   Personal Awareness
   Grief Theories
   Grief Reactions
   What Helps




09/28/12           Janice Firn, L.M.S.W., Clinical   2
                   Social Worker, UofM Hospital
What’s the first thing you think
  of when I say the word “grief”?




09/28/12     Janice Firn, L.M.S.W., Clinical   3
             Social Worker, UofM Hospital
“Grief”
    Loss?
                                                        Stages?
    Sadness?
                                                        Tasks?
    Separation?
                                                        Symptoms?
    Anguish?
                                                        Adaptive?
    Change?
                                                        Normal?
    Ache?
                                                        Complicated?
    Hurt?
                                                        Pathological?


09/28/12           Janice Firn, L.M.S.W., Clinical                 4
                   Social Worker, UofM Hospital
Grief is an…
   Emotional
   Mental
   Social
   Spiritual
   Physical
    …response to loss




09/28/12            Janice Firn, L.M.S.W., Clinical   5
                    Social Worker, UofM Hospital
Why talk about Grief?
   Change happens!

   To live is to experience loss

   “Little deaths”

   “Change is Inevitable—Growth is Optional.”
                           - Walt Disney
09/28/12              Janice Firn, L.M.S.W., Clinical   6
                      Social Worker, UofM Hospital
Why do we feel Grief?
   Attachment Theory
   Types of Attachments
          Secure
          Avoidant
          Anxious
          Ambivalent




09/28/12                Janice Firn, L.M.S.W., Clinical   7
                        Social Worker, UofM Hospital
Why talk about Grief?
             “Working through our endings
               allows us to redefine our
               relationships,
             to surrender what is dead and to
               accept what is alive,
             and to be in the world more fully to
               face the new situation.
                              - Stanley Keleman
                                                   (from Living Your Dying)


09/28/12         Janice Firn, L.M.S.W., Clinical                        8
                 Social Worker, UofM Hospital
Personal Awareness of Grief & Loss

                                        Perception is Key
                                        Individual Response
                                        Frequency of
                                         Exposure




09/28/12     Janice Firn, L.M.S.W., Clinical                   9
             Social Worker, UofM Hospital
Myths About Grief
   Myth: The pain of the loss will go away faster
    if you ignore it.
   Myth: It’s important to be “be strong” in the
    face of loss.
   Myth: If you don’t cry, it means you aren’t
    sorry about the loss.
   Myth: Grief should last about a year.

09/28/12           Janice Firn, L.M.S.W., Clinical   10
                   Social Worker, UofM Hospital
Facts About Grief
    Fact: Trying to ignore your pain or keep it from
     surfacing will only make it worse in the long run.
    Fact: Feeling sad, frightened, or lonely is a normal
     reaction to loss. Showing your true feelings can help
     you and others deal with the grief.
    Fact: Crying is a normal response to sadness, but
     it’s not the only one.
    Fact: There is no right or wrong time frame for
     grieving.
    09/28/12           Janice Firn, L.M.S.W., Clinical   11
                       Social Worker, UofM Hospital
Kubler-Ross
The five stages of grief:
1. Denial/Shock: “This can’t be happening to me.”
2.     Anger: “Why is this happening? Who is to blame?
       What should have been done differently…”
3.     Bargaining: “Make this not happen, and in return I
       will ____.”
4.     Depression: “I’m too sad to do anything.”
5.     Acceptance: “I’m able to exist with what
       happened.”
09/28/12              Janice Firn, L.M.S.W., Clinical    12
                      Social Worker, UofM Hospital
Stroebe & Schut
    Dual Process Model
    Oscillating between a ‘Loss-
     oriented’ state and a
     ‘Restoration-oriented’ state
    Loss-oriented: more
     emotional work of grief
    Restoration-oriented: more
     task-focused grief work
    Adaptive denial and distraction
     from the emotional work of
     grief
    09/28/12               Janice Firn, L.M.S.W., Clinical   13
                           Social Worker, UofM Hospital
Martin & Doka
   Grieving Styles: contrasting patterns of grieving and
    mourning
   Patterns which are not related solely to gender, but to ‘style’
    of mourning
      Intuitive – emphasizing the experiencing and expression

       of emotion
      Instrumental – focuses on practical matters and problem

       solving
   These contrasting styles are poles on a spectrum or continuum
   Related more to socialization and personality types than to
    gender

09/28/12                Janice Firn, L.M.S.W., Clinical           14
                        Social Worker, UofM Hospital
J. William Worden
   Physiological healing is needed to bring the
    body back into physical health – this type of
    healing takes time.
   Similarly, after a loss it takes time to return to
    an emotional state of well-being.
   The 4 tasks of mourning are an essential part
    of the healing process.
   No specific order, but still must be worked
    through during the time of grieving.
09/28/12             Janice Firn, L.M.S.W., Clinical     15
                     Social Worker, UofM Hospital
The 4 Tasks of Mourning
                      1.      Accept the reality of the
                              loss
                      2.      Experience and work
                              through the pain of grief
                      3.      Adjust to the new
                              “normal”; life without what
                              was lost
                      4.      Emotionally relocate the
                              loss and move forward in
                              life
09/28/12          Janice Firn, L.M.S.W., Clinical           16
                  Social Worker, UofM Hospital
Accept the Reality
   To come full face with the fact that your loss is real
    and will not return, i.e. that immediate reunion or
    regaining it is impossible.

   Obstacles:
   Denying the facts of loss.
   Denying the meaning of the loss, e.g. “It wasn’t a
    good job anyway”, or “I don’t miss him,” or “I’m just
    as healthy as I ever was.”
   Minimizing the loss. “It’s not that big of a deal.”
09/28/12              Janice Firn, L.M.S.W., Clinical        17
                      Social Worker, UofM Hospital
Experience & Work
            Through the Pain
 It is impossible to lose something or someone you
  have been deeply attached to without experiencing
  some level of pain.

 Obstacles:
   Not allowing yourself to feel.

   Cutting off your feelings and denying that pain is
    present.
   Avoiding reminders of the loss – e.g., trying to
    find a ‘geographic cure’ by moving to another
    location, or travelling
09/28/12            Janice Firn, L.M.S.W., Clinical      18
                    Social Worker, UofM Hospital
The New “Normal”
 Coming to terms with being without (maybe raising children
  alone, facing future unemployment or handicap, redefinition of
  self, etc.).
  A. External Adjustments : how the loss affects your everyday
       functioning in the world
  B. Internal Adjustments: how the loss affects your sense of self
  C. Spiritual Adjustments: how the loss affects your beliefs,
       values and assumptions about the world
    Obstacles:
       Promoting your own helplessness.
       Not developing the skills you need to cope or to function in
        new roles.
       Withdrawing from the world. Refusing to see yourself or the
        world differently.
    09/28/12              Janice Firn, L.M.S.W., Clinical         19
                          Social Worker, UofM Hospital
Moving Forward
   To find a place for what was lost that will enable us to remain
    connected with them/it but in a way that will not keep us from
    going on with life.

   Obstacles:
     Withdrawal from others and life. Unwillingness to love.

     Unwillingness to risk; making a vow to never invest

      yourself again.
     Holding on so tight to the past that you’re unable to form

      new relationships or develop new skills.



09/28/12                 Janice Firn, L.M.S.W., Clinical           20
                         Social Worker, UofM Hospital
When is Grieving Over?
 When a person can think of what was lost without
      acute pain.
 When the tasks of mourning have been accomplished.
 When one can think of the what was lost without
      physical manifestations such as crying or feeling
      tightness in the chest.
 When one can reinvest his/her emotions into life and
      the living.
 When one can regain an interest in life, feel more
      hopeful, experience gratification again, and adapt to
      new roles.
 Is there a time limit? 1 year? 4 seasons? 2 years? It
      depends.
09/28/12                Janice Firn, L.M.S.W., Clinical    21
                     Social Worker, UofM Hospital
Grieving is Necessary!

  “Man, when he does
       not grieve,
    hardly exists.”

    - Antonio Porchia



09/28/12          Janice Firn, L.M.S.W., Clinical   22
                  Social Worker, UofM Hospital
Normal Grief Reactions
                                    Emotional
                                    Physical
                                    Cognitive



      Behavioral
      Spiritual
09/28/12            Janice Firn, L.M.S.W., Clinical   23
                    Social Worker, UofM Hospital
Grief vs. Depression
              Grief is a roller coaster.




              Depression is dead end.
09/28/12          Janice Firn, L.M.S.W., Clinical   24
                  Social Worker, UofM Hospital
Tensions for Families
Hope                                  Despair
Denial                                Acceptance
Meaninglessness                       Meaningfulness
Independence                          Accepting Interdependence
Ambiguity                             Certainty of Outcome
Making Plans                          Experiencing Emotions
Holding On                            Letting Go
Speaking Openly                       Not Talking
Family as it Was                      Family as it is Becoming

 09/28/12          Janice Firn, L.M.S.W., Clinical          25
                   Social Worker, UofM Hospital
When Grief Isn’t Healing

   Relational Factors
   Circumstantial Factors
   Historical Factors
   Personality Factors
   Social Factors




09/28/12             Janice Firn, L.M.S.W., Clinical   26
                     Social Worker, UofM Hospital
When Grief Isn’t Healing

                                 Chronic grief

                                 Delayed grief reactions

                                 Avoiding grieving


09/28/12          Janice Firn, L.M.S.W., Clinical       27
                  Social Worker, UofM Hospital
Grief WORK
   Grief therapy: goal is not about forgetting but
    remembering with less pain.
   Developing adaptive coping mechanisms.
   Finding meaning.
   AA and Al-Anon, NA and Nar-Anon = grief work




09/28/12           Janice Firn, L.M.S.W., Clinical    28
                   Social Worker, UofM Hospital
Getting Support When
                   You Are Grieving
   Do not grieve alone
        Turn to friends and family members
        Join a support group
        Talk to a therapist or grief counselor
   Face your feelings
   Express your feelings in a tangible
    or creative way.
   Look after your physical health.
   Plan ahead for grief “triggers”.
    09/28/12                 Janice Firn, L.M.S.W., Clinical   29
                             Social Worker, UofM Hospital
Helping Someone who is Grieving
                            Listen
                            Acknowledge the
                             uniqueness of grief
                            Offer practical help
                            Make contact, write a
                             personal note
                            Be aware of holidays
                             and anniversaries

09/28/12      Janice Firn, L.M.S.W., Clinical        30
              Social Worker, UofM Hospital
“Grief heals when it is received by




09/28/12      Janice Firn, L.M.S.W., Clinical   31
              Social Worker, UofM Hospital
Resources
   J. William Worden, Grief Counseling & Grief Therapy, 2008.
   Judith Viorst, Necessary Losses, 2002.
   Holmes-Rahe Social Readjustment Rating Scale. Journal of Psychosomatic Research, (1967).
    Vol. 11, pp. 213-218.
   Lynn, J. and Harrold, J. (1999). Handbook for Mortals: Guidance for People Facing Serious
    Illness, p.41.
   Al-Anon Dist. 5, http://www.hvcn.org/info/afg5/griefloss.htm
   HelpGuide.org, http://71.6.131.182/mental/grief_loss.htm
   Dennis C. Daley & G. Alan Marlatt, Overcoming your Alcohol or Drug Problem, 2006.
   Wolfet, A. (2009). The Handbook for Companioning the Mourner. Companion Press:
    Colorado.
   Abbot, A., Alcohol, Tobacco, and Other Drugs. NASW, 2010.
   http://www.hospicenet.org
   Maciejewski, Zhang, Block, Prigerson, (2010) “An Empirical Examination of the Stage
    Theory of Grief”, JAMA
   Stroebe, M., & Schut, H., (1999). The dual process model of coping with bereavement:
    rationale and description. Death Studies,197-224.
   Doka, K., & Martin, T. (1999). Men Don't Cry, Women Do: Transcending Gender Stereotypes
    of Grief.
09/28/12                         Janice Firn, L.M.S.W., Clinical                           32
                                 Social Worker, UofM Hospital
Grief and Loss in
Addiction and Recovery
Matt Statman, LLMSW, CADC
Dawn Farm
Education          September
  Series             2012
"To spare oneself from grief at all
cost can be achieved only at the
 price of total detachment, which
excludes the ability to experience
            happiness."
        Dr. Erich Fromm
o Unresolved grief, loss & trauma often
  predate use
o Compounded in addiction
o Complicated by use
Loss in Addiction

oMinimized
oNormalized
oNumb / disassociate
Grief in addiction

o Use AOD to cope
o Lack healthy support
o Medicate / Avoid / Minimize feelings
o Grief not processed
o Losses not fully grieved
Examples of Losses in
          Addiction
o Experiences and events
o Relationships with family/friends
o Parenting time
o Family milestones
o Deaths
o Time
o Opportunities
o Perinatal
o Spiritual
Losses in moving from addiction to
           recovery…
 “What are you leaving behind?”
Loss of drug (s) …
o Relationship with substance is
  primary
o Constant reminders of this loss in
  early recovery
o Important loss that can easily be
  minimized
Loss of self…
o Early onset - identity formed around AOD –
  You have to give up who you are to become
  who you can be
o Addiction forces people to live outside their
  values - guilt and shame
o Loss of hopes, plans, aspirations and dreams
o Loss of innocence, dignity, self-esteem,
  choice, control of one’s body
Loss of rituals etc…
o Loss over rituals “ The lifestyle”
o Loss of coping mechanisms and
  survival techniques
o Loss of culture of addiction
o Loss of using friends / relatives
o Etc…
In early recovery people
begin to realize that they
have lost a lot…
Barriers to Grieving
o Lack of safety/ trust
o Unable to feel / identify feelings
o Feelings unfreeze - feel
  overwhelming
o Seemingly unrelated feelings may
  arise (anger, depression, anxiety)
o Complicated by guilt/shame/
  stigma/ trauma
Feelings - Early Recovery
o Unable to verbalize
o Lack healthy coping skills
o May seek relief through compulsive
  behaviors/ other addictions /
  relapse
Avoidance


Inability or unwillingness
to grieve can be a barrier
to recovery/getting well/
building relationships
“… If you're an addict on the road to
 recovery, be prepared to experience
 emotions in a new way – the good and
 bad; and be sure to have a plan in place
 to fight off the cravings while you're in
 that vulnerable state.”
–Michael Bloch
“The best therapy for grief is
   time and community.”
       -Michael S. Logan
Recovery is a Process
Grief recovery, like addiction
recovery, is not a linear process
In recovery people
 acknowledge, understand,
and accept losses and move
        through grief
o Safe and supportive
 environment
o Community
o Additional support
Some Tasks
o Develop skills to cope with
 feelings
o Open up, identify and talk about
  losses
o Learn to identify feelings
o Learn to verbalize feelings
o Learn to tolerate “negative”
 feelings
Grief recovery …
o Healthy grieving enables the
  recovering person to confront and
  accept the reality of the loss, and
  find purpose and meaning for life
o Losses are eventually remembered
  with less pain.


   Things will get better
“Have You A Sufficient
    Substitute?”
         AA Page 152
New Rituals
Recovery offers:
Opportunity to grieve lost
relationships, heal old ones,
build new ones and make
meaning of past by helping
others




                                .
Opportunity to connect / reconnect
 with one’s spiritual self and to grow
 spiritually
The Most Satisfying Years of
Your Existence Lie Ahead”
           AA Page 152
What About Loved Ones?
“The reaction to loss that is widely experienced
 by friends and family members of persons who
 are addicted to mind altering substances is
 profound grief. It has characteristics of flawed
 interactional patterns because the loss is
 ambiguous. If a person dies, the grief is
 unambiguous: the social role the deceased
 played is no longer occupied and the
 deceased cannot fulfill obligations or promises.
 The spouse who becomes addicted to mind
 altering substances often ceases to fulfill
 obligations or promises, but physically the
 social role is still occupied.”
-Vicki Loyer-Carlson, Ph.D., LMFT
Losses may include

o   Relationships
o   Financial security
o   Hopes and dreams
o   Self-esteem
o   Emotional support, “presence”
o   Other important tangible and
    intangible things
Complicated
o Painful experiences/memories
o Complex feelings (resentment,
  anger)
o Stigma, secrecy , shame
o Loss of contact by choice
o Incarceration
o Death
Grief feels lonely for family and friends
 and circumstances may be especially
 challenging - but help, support and
 understanding is available, and
 healing is possible
Grief recovery is hard work
 for family and friends too –
  but it is worth the effort!
Grief triggers
Being triggered is normal
          and OK
   Grief recovery, like
  addiction recovery, is
          ongoing
Triggering Events
o Anniversaries
o National tragedies
o Others having a similar experience
o Holidays
o ___________
o ___________
o ___________
Take Action
o Identify sources of support
o Talk about it
o Plan ahead (more meetings, more social
  contact, more service work, more
  spiritual practice etc…)
Social support
Help from community …
o A safe placed to be open about feelings
  and experiences, without shame
o Step work helps people express grief,
  gain perspective and acceptance,
  forgive and move on with their lives
o Provides opportunities to give back to
  others and make meaning
o Peer grief support groups can be
  helpful
Support from
  family/friends/others …
Helpers
o It’s ok / important to just be there
  / sit / listen
o Avoid trying to fix - It’s ok to say
  “This sucks!” or “I am so sorry!”
o If it is out of your league refer to
  professionals
Grievers
o Let family/friends/coworkers/others
  know what you need
o Support dissipates over time - continue
  to ask for support
o If family/friends are unavailable or
  unsupportive (including well-intentioned
  but misguided efforts to be supportive)
  –seek support elsewhere
Spiritual support
o Participation in faith community
  activities/rituals
o Faith-based support groups or prayer
  groups
o Prayer, mindfulness, meditation
o One’s chosen spiritual practices and
  rituals
Rituals …
 Grief rituals and ceremonies acknowledge the pain
 of loss while offering social support and a
 reaffirmation of life …
Tributes …
o Creating a tribute, legacy
  or memorial to honor and
  remember a loved one
  can provide comfort
o People often find comfort
  in donating to a related
  cause and/or becoming
  involved in volunteer or
  service work, or other
  ways of helping others
Experiential techniques …
- experiential therapies (art, writing,
  music) engage areas of the brain
 music) engage areas of the brain
 involved in grief, memory, healing,
 recovery
Self care …
o Participation in mutual aid groups / social
  support
o Nutrition
o Exercise
o Adequate rest and sleep
o Activities to engage in that help with healing
  and regaining a feeling of purpose
o Internet resources
o Literature
Professional Help
• Complicated grief may require extra help
• Resources are available
Barb Smith
Author of “Brent’s World”
Grief and Loss in Addiction and Recovery - September 2012

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Grief and Loss in Addiction and Recovery - September 2012

  • 1. Grief & Loss in Addiction & Recovery Theory, Personal Awareness, Grief Reactions, & What Helps
  • 2. Overview  Why Talk About Grief?  Personal Awareness  Grief Theories  Grief Reactions  What Helps 09/28/12 Janice Firn, L.M.S.W., Clinical 2 Social Worker, UofM Hospital
  • 3. What’s the first thing you think of when I say the word “grief”? 09/28/12 Janice Firn, L.M.S.W., Clinical 3 Social Worker, UofM Hospital
  • 4. “Grief”  Loss?  Stages?  Sadness?  Tasks?  Separation?  Symptoms?  Anguish?  Adaptive?  Change?  Normal?  Ache?  Complicated?  Hurt?  Pathological? 09/28/12 Janice Firn, L.M.S.W., Clinical 4 Social Worker, UofM Hospital
  • 5. Grief is an…  Emotional  Mental  Social  Spiritual  Physical …response to loss 09/28/12 Janice Firn, L.M.S.W., Clinical 5 Social Worker, UofM Hospital
  • 6. Why talk about Grief?  Change happens!  To live is to experience loss  “Little deaths”  “Change is Inevitable—Growth is Optional.” - Walt Disney 09/28/12 Janice Firn, L.M.S.W., Clinical 6 Social Worker, UofM Hospital
  • 7. Why do we feel Grief?  Attachment Theory  Types of Attachments  Secure  Avoidant  Anxious  Ambivalent 09/28/12 Janice Firn, L.M.S.W., Clinical 7 Social Worker, UofM Hospital
  • 8. Why talk about Grief? “Working through our endings allows us to redefine our relationships, to surrender what is dead and to accept what is alive, and to be in the world more fully to face the new situation. - Stanley Keleman (from Living Your Dying) 09/28/12 Janice Firn, L.M.S.W., Clinical 8 Social Worker, UofM Hospital
  • 9. Personal Awareness of Grief & Loss  Perception is Key  Individual Response  Frequency of Exposure 09/28/12 Janice Firn, L.M.S.W., Clinical 9 Social Worker, UofM Hospital
  • 10. Myths About Grief  Myth: The pain of the loss will go away faster if you ignore it.  Myth: It’s important to be “be strong” in the face of loss.  Myth: If you don’t cry, it means you aren’t sorry about the loss.  Myth: Grief should last about a year. 09/28/12 Janice Firn, L.M.S.W., Clinical 10 Social Worker, UofM Hospital
  • 11. Facts About Grief  Fact: Trying to ignore your pain or keep it from surfacing will only make it worse in the long run.  Fact: Feeling sad, frightened, or lonely is a normal reaction to loss. Showing your true feelings can help you and others deal with the grief.  Fact: Crying is a normal response to sadness, but it’s not the only one.  Fact: There is no right or wrong time frame for grieving. 09/28/12 Janice Firn, L.M.S.W., Clinical 11 Social Worker, UofM Hospital
  • 12. Kubler-Ross The five stages of grief: 1. Denial/Shock: “This can’t be happening to me.” 2. Anger: “Why is this happening? Who is to blame? What should have been done differently…” 3. Bargaining: “Make this not happen, and in return I will ____.” 4. Depression: “I’m too sad to do anything.” 5. Acceptance: “I’m able to exist with what happened.” 09/28/12 Janice Firn, L.M.S.W., Clinical 12 Social Worker, UofM Hospital
  • 13. Stroebe & Schut  Dual Process Model  Oscillating between a ‘Loss- oriented’ state and a ‘Restoration-oriented’ state  Loss-oriented: more emotional work of grief  Restoration-oriented: more task-focused grief work  Adaptive denial and distraction from the emotional work of grief 09/28/12 Janice Firn, L.M.S.W., Clinical 13 Social Worker, UofM Hospital
  • 14. Martin & Doka  Grieving Styles: contrasting patterns of grieving and mourning  Patterns which are not related solely to gender, but to ‘style’ of mourning  Intuitive – emphasizing the experiencing and expression of emotion  Instrumental – focuses on practical matters and problem solving  These contrasting styles are poles on a spectrum or continuum  Related more to socialization and personality types than to gender 09/28/12 Janice Firn, L.M.S.W., Clinical 14 Social Worker, UofM Hospital
  • 15. J. William Worden  Physiological healing is needed to bring the body back into physical health – this type of healing takes time.  Similarly, after a loss it takes time to return to an emotional state of well-being.  The 4 tasks of mourning are an essential part of the healing process.  No specific order, but still must be worked through during the time of grieving. 09/28/12 Janice Firn, L.M.S.W., Clinical 15 Social Worker, UofM Hospital
  • 16. The 4 Tasks of Mourning 1. Accept the reality of the loss 2. Experience and work through the pain of grief 3. Adjust to the new “normal”; life without what was lost 4. Emotionally relocate the loss and move forward in life 09/28/12 Janice Firn, L.M.S.W., Clinical 16 Social Worker, UofM Hospital
  • 17. Accept the Reality  To come full face with the fact that your loss is real and will not return, i.e. that immediate reunion or regaining it is impossible.  Obstacles:  Denying the facts of loss.  Denying the meaning of the loss, e.g. “It wasn’t a good job anyway”, or “I don’t miss him,” or “I’m just as healthy as I ever was.”  Minimizing the loss. “It’s not that big of a deal.” 09/28/12 Janice Firn, L.M.S.W., Clinical 17 Social Worker, UofM Hospital
  • 18. Experience & Work Through the Pain  It is impossible to lose something or someone you have been deeply attached to without experiencing some level of pain.  Obstacles:  Not allowing yourself to feel.  Cutting off your feelings and denying that pain is present.  Avoiding reminders of the loss – e.g., trying to find a ‘geographic cure’ by moving to another location, or travelling 09/28/12 Janice Firn, L.M.S.W., Clinical 18 Social Worker, UofM Hospital
  • 19. The New “Normal”  Coming to terms with being without (maybe raising children alone, facing future unemployment or handicap, redefinition of self, etc.). A. External Adjustments : how the loss affects your everyday functioning in the world B. Internal Adjustments: how the loss affects your sense of self C. Spiritual Adjustments: how the loss affects your beliefs, values and assumptions about the world  Obstacles:  Promoting your own helplessness.  Not developing the skills you need to cope or to function in new roles.  Withdrawing from the world. Refusing to see yourself or the world differently. 09/28/12 Janice Firn, L.M.S.W., Clinical 19 Social Worker, UofM Hospital
  • 20. Moving Forward  To find a place for what was lost that will enable us to remain connected with them/it but in a way that will not keep us from going on with life.  Obstacles:  Withdrawal from others and life. Unwillingness to love.  Unwillingness to risk; making a vow to never invest yourself again.  Holding on so tight to the past that you’re unable to form new relationships or develop new skills. 09/28/12 Janice Firn, L.M.S.W., Clinical 20 Social Worker, UofM Hospital
  • 21. When is Grieving Over?  When a person can think of what was lost without acute pain.  When the tasks of mourning have been accomplished.  When one can think of the what was lost without physical manifestations such as crying or feeling tightness in the chest.  When one can reinvest his/her emotions into life and the living.  When one can regain an interest in life, feel more hopeful, experience gratification again, and adapt to new roles.  Is there a time limit? 1 year? 4 seasons? 2 years? It depends. 09/28/12 Janice Firn, L.M.S.W., Clinical 21 Social Worker, UofM Hospital
  • 22. Grieving is Necessary! “Man, when he does not grieve, hardly exists.” - Antonio Porchia 09/28/12 Janice Firn, L.M.S.W., Clinical 22 Social Worker, UofM Hospital
  • 23. Normal Grief Reactions  Emotional  Physical  Cognitive  Behavioral  Spiritual 09/28/12 Janice Firn, L.M.S.W., Clinical 23 Social Worker, UofM Hospital
  • 24. Grief vs. Depression Grief is a roller coaster. Depression is dead end. 09/28/12 Janice Firn, L.M.S.W., Clinical 24 Social Worker, UofM Hospital
  • 25. Tensions for Families Hope Despair Denial Acceptance Meaninglessness Meaningfulness Independence Accepting Interdependence Ambiguity Certainty of Outcome Making Plans Experiencing Emotions Holding On Letting Go Speaking Openly Not Talking Family as it Was Family as it is Becoming 09/28/12 Janice Firn, L.M.S.W., Clinical 25 Social Worker, UofM Hospital
  • 26. When Grief Isn’t Healing  Relational Factors  Circumstantial Factors  Historical Factors  Personality Factors  Social Factors 09/28/12 Janice Firn, L.M.S.W., Clinical 26 Social Worker, UofM Hospital
  • 27. When Grief Isn’t Healing  Chronic grief  Delayed grief reactions  Avoiding grieving 09/28/12 Janice Firn, L.M.S.W., Clinical 27 Social Worker, UofM Hospital
  • 28. Grief WORK  Grief therapy: goal is not about forgetting but remembering with less pain.  Developing adaptive coping mechanisms.  Finding meaning.  AA and Al-Anon, NA and Nar-Anon = grief work 09/28/12 Janice Firn, L.M.S.W., Clinical 28 Social Worker, UofM Hospital
  • 29. Getting Support When You Are Grieving  Do not grieve alone  Turn to friends and family members  Join a support group  Talk to a therapist or grief counselor  Face your feelings  Express your feelings in a tangible or creative way.  Look after your physical health.  Plan ahead for grief “triggers”. 09/28/12 Janice Firn, L.M.S.W., Clinical 29 Social Worker, UofM Hospital
  • 30. Helping Someone who is Grieving  Listen  Acknowledge the uniqueness of grief  Offer practical help  Make contact, write a personal note  Be aware of holidays and anniversaries 09/28/12 Janice Firn, L.M.S.W., Clinical 30 Social Worker, UofM Hospital
  • 31. “Grief heals when it is received by 09/28/12 Janice Firn, L.M.S.W., Clinical 31 Social Worker, UofM Hospital
  • 32. Resources  J. William Worden, Grief Counseling & Grief Therapy, 2008.  Judith Viorst, Necessary Losses, 2002.  Holmes-Rahe Social Readjustment Rating Scale. Journal of Psychosomatic Research, (1967). Vol. 11, pp. 213-218.  Lynn, J. and Harrold, J. (1999). Handbook for Mortals: Guidance for People Facing Serious Illness, p.41.  Al-Anon Dist. 5, http://www.hvcn.org/info/afg5/griefloss.htm  HelpGuide.org, http://71.6.131.182/mental/grief_loss.htm  Dennis C. Daley & G. Alan Marlatt, Overcoming your Alcohol or Drug Problem, 2006.  Wolfet, A. (2009). The Handbook for Companioning the Mourner. Companion Press: Colorado.  Abbot, A., Alcohol, Tobacco, and Other Drugs. NASW, 2010.  http://www.hospicenet.org  Maciejewski, Zhang, Block, Prigerson, (2010) “An Empirical Examination of the Stage Theory of Grief”, JAMA  Stroebe, M., & Schut, H., (1999). The dual process model of coping with bereavement: rationale and description. Death Studies,197-224.  Doka, K., & Martin, T. (1999). Men Don't Cry, Women Do: Transcending Gender Stereotypes of Grief. 09/28/12 Janice Firn, L.M.S.W., Clinical 32 Social Worker, UofM Hospital
  • 33. Grief and Loss in Addiction and Recovery Matt Statman, LLMSW, CADC Dawn Farm Education September Series 2012
  • 34. "To spare oneself from grief at all cost can be achieved only at the price of total detachment, which excludes the ability to experience happiness." Dr. Erich Fromm
  • 35. o Unresolved grief, loss & trauma often predate use o Compounded in addiction o Complicated by use
  • 37. Grief in addiction o Use AOD to cope o Lack healthy support o Medicate / Avoid / Minimize feelings o Grief not processed o Losses not fully grieved
  • 38. Examples of Losses in Addiction o Experiences and events o Relationships with family/friends o Parenting time o Family milestones o Deaths o Time o Opportunities o Perinatal o Spiritual
  • 39. Losses in moving from addiction to recovery… “What are you leaving behind?”
  • 40. Loss of drug (s) …
  • 41. o Relationship with substance is primary o Constant reminders of this loss in early recovery o Important loss that can easily be minimized
  • 43. o Early onset - identity formed around AOD – You have to give up who you are to become who you can be o Addiction forces people to live outside their values - guilt and shame o Loss of hopes, plans, aspirations and dreams o Loss of innocence, dignity, self-esteem, choice, control of one’s body
  • 44. Loss of rituals etc…
  • 45. o Loss over rituals “ The lifestyle” o Loss of coping mechanisms and survival techniques o Loss of culture of addiction o Loss of using friends / relatives o Etc…
  • 46. In early recovery people begin to realize that they have lost a lot…
  • 47. Barriers to Grieving o Lack of safety/ trust o Unable to feel / identify feelings o Feelings unfreeze - feel overwhelming o Seemingly unrelated feelings may arise (anger, depression, anxiety) o Complicated by guilt/shame/ stigma/ trauma
  • 48. Feelings - Early Recovery o Unable to verbalize o Lack healthy coping skills o May seek relief through compulsive behaviors/ other addictions / relapse
  • 49. Avoidance Inability or unwillingness to grieve can be a barrier to recovery/getting well/ building relationships
  • 50. “… If you're an addict on the road to recovery, be prepared to experience emotions in a new way – the good and bad; and be sure to have a plan in place to fight off the cravings while you're in that vulnerable state.” –Michael Bloch
  • 51. “The best therapy for grief is time and community.” -Michael S. Logan
  • 52. Recovery is a Process Grief recovery, like addiction recovery, is not a linear process
  • 53. In recovery people acknowledge, understand, and accept losses and move through grief
  • 54. o Safe and supportive environment o Community o Additional support
  • 55. Some Tasks o Develop skills to cope with feelings o Open up, identify and talk about losses o Learn to identify feelings o Learn to verbalize feelings o Learn to tolerate “negative” feelings
  • 56. Grief recovery … o Healthy grieving enables the recovering person to confront and accept the reality of the loss, and find purpose and meaning for life o Losses are eventually remembered with less pain. Things will get better
  • 57. “Have You A Sufficient Substitute?” AA Page 152
  • 59. Recovery offers: Opportunity to grieve lost relationships, heal old ones, build new ones and make meaning of past by helping others .
  • 60. Opportunity to connect / reconnect with one’s spiritual self and to grow spiritually
  • 61. The Most Satisfying Years of Your Existence Lie Ahead” AA Page 152
  • 63. “The reaction to loss that is widely experienced by friends and family members of persons who are addicted to mind altering substances is profound grief. It has characteristics of flawed interactional patterns because the loss is ambiguous. If a person dies, the grief is unambiguous: the social role the deceased played is no longer occupied and the deceased cannot fulfill obligations or promises. The spouse who becomes addicted to mind altering substances often ceases to fulfill obligations or promises, but physically the social role is still occupied.” -Vicki Loyer-Carlson, Ph.D., LMFT
  • 64. Losses may include o Relationships o Financial security o Hopes and dreams o Self-esteem o Emotional support, “presence” o Other important tangible and intangible things
  • 65. Complicated o Painful experiences/memories o Complex feelings (resentment, anger) o Stigma, secrecy , shame o Loss of contact by choice o Incarceration o Death
  • 66. Grief feels lonely for family and friends and circumstances may be especially challenging - but help, support and understanding is available, and healing is possible
  • 67. Grief recovery is hard work for family and friends too – but it is worth the effort!
  • 69. Being triggered is normal and OK Grief recovery, like addiction recovery, is ongoing
  • 70. Triggering Events o Anniversaries o National tragedies o Others having a similar experience o Holidays o ___________ o ___________ o ___________
  • 71. Take Action o Identify sources of support o Talk about it o Plan ahead (more meetings, more social contact, more service work, more spiritual practice etc…)
  • 72. Social support Help from community …
  • 73. o A safe placed to be open about feelings and experiences, without shame o Step work helps people express grief, gain perspective and acceptance, forgive and move on with their lives o Provides opportunities to give back to others and make meaning o Peer grief support groups can be helpful
  • 74. Support from family/friends/others …
  • 75. Helpers o It’s ok / important to just be there / sit / listen o Avoid trying to fix - It’s ok to say “This sucks!” or “I am so sorry!” o If it is out of your league refer to professionals
  • 76. Grievers o Let family/friends/coworkers/others know what you need o Support dissipates over time - continue to ask for support o If family/friends are unavailable or unsupportive (including well-intentioned but misguided efforts to be supportive) –seek support elsewhere
  • 78. o Participation in faith community activities/rituals o Faith-based support groups or prayer groups o Prayer, mindfulness, meditation o One’s chosen spiritual practices and rituals
  • 79. Rituals … Grief rituals and ceremonies acknowledge the pain of loss while offering social support and a reaffirmation of life …
  • 80. Tributes … o Creating a tribute, legacy or memorial to honor and remember a loved one can provide comfort o People often find comfort in donating to a related cause and/or becoming involved in volunteer or service work, or other ways of helping others
  • 81. Experiential techniques … - experiential therapies (art, writing, music) engage areas of the brain music) engage areas of the brain involved in grief, memory, healing, recovery
  • 83. o Participation in mutual aid groups / social support o Nutrition o Exercise o Adequate rest and sleep o Activities to engage in that help with healing and regaining a feeling of purpose o Internet resources o Literature
  • 84. Professional Help • Complicated grief may require extra help • Resources are available
  • 85. Barb Smith Author of “Brent’s World”

Hinweis der Redaktion

  1. It is how we integrate the losses we experience into our lives, how we adapt to the changes that move us forward into new definitions of ourselves, growth happens from living through the loss and redefining ourselves. Any time there is a change a loss is experienced whether one realizes it or not.
  2. Attachment theory describes the dynamics of long-term relationships between humans. Attachments to people, animals, things, rituals, etc. The more avoidant, anxious, or ambivalent the relationship the more complex and conflicted the grief reaction
  3. The goal of grief work is to more fully engage in life and to be open to the future.
  4. No relationship is like another. How a loss impacts us will depend on the unique relationship we had with what is lost. If one perceives the loss as important or life altering than that is what it is. Additionally, the impact of the loss can be magnified by the number of losses experienced over time, our reserve for coping with the loss can be depleted if there are too many within a short time period. Life Events Scale Handout
  5. Dual processing model addresses the balance between focusing on feelings and focusing on the practical tasks that move you through loss
  6. The type of loss, the situation surrounding the loss, your personality, and the characteristics of the unique relationship with what was lost/how significant the loss is to you, etc. will all impact how grief looks and how long it lasts. For very significant losses the grief may never go away altogether, it may ease for a while only to resurface at key anniversaries or holidays.
  7. Kubler-Ross has said that these are not linear and do not have to be completed in order, one can vacillate between them over time. Often immediately after a loss feelings of denial/shock and depression can surface, over time as denial and shock wear off, acceptance grows. Maciejewski, Zhang, Block, Prigerson, “An Empirical Examination of the Stage Theory of Grief”, JAMA, January 11, 2010
  8. his model identifies two types of stressors, loss- and restoration-oriented, and a dynamic, regulatory coping process of oscillation, whereby the grieving individual at times confronts, at other times avoids, the different tasks of grieving. This model proposes that adaptive coping is composed of confrontation--avoidance of loss and restoration stressors. It also argues the need for dosage of grieving, that is, the need to take respite from dealing with either of these stressors, as an integral part of adaptive coping.
  9. Men Don’t Cry . . . Women Do: Transcending Gender Stereotypes of Grief , by Martin and Doka
  10. Just like after an injury heals we sometimes are reminded of the old injury so too with grief. The would gets better, the grief heals but sometimes there is a twinge. Tasks implies WORK
  11. “ let it be Tuesday” syndrome Substance use can prevent someone from working through this task, prevents one from having to face reality.
  12. Substance abuse numbs the pain and prevents someone from working through this task. Recovery can be a time of facing a number of losses, providing a safe, supportive place to allow you to feel your feelings and work through the pain of the loss – it seems an impossible task but it can be done.
  13. Recovery helps to build new coping skills and to redefine who you are so that you can engage the world differently. Recovery helps you see yourself and the world differently.
  14. Working through recovery allows us to be at peace with the past, to be vulnerable to life in a health way, to form new attachments, to forgive and to ask forgiveness.
  15. Is it ever really over? No. It does get easier though.
  16. The type of life we live depends on how we work through our grieving. Good grieving engages us more fully into life.
  17. Grieving is an Emotional, Mental, Social, Spiritual, and Physical response to a loss. Behavioral – crying, listlessness, sleeplessness, sleepiness Spiritual – wondering about meaning and purpose Emotional – shock, sadness, anger, relief, release, guilt Physical – numbness, empty feeling, tight chest, shortness of breath Cognitive – reviewing what occurred, thinking about what was lost
  18. Grief: the way I am feeling makes sense in light of what happened, these losses are the source for what I am going through, others have validated my losses. I am distracted easily, I wish I looked better – sometimes I feel better than I look, sometimes I look better than I feel. Some people have avoided me or been insensitive since the loss. At times I prefer to be alone and it’s an effort to do things. I am more aware of the fragility of life as a result of what has happened. It’s hard to concentrate but I can if I have to, I’m often preoccupied by thoughts of what I have lost. My heart feels broken. I am very angry, then I am very sad. I yearn to love again. At times I forget and am happy, then I remember again. I pray for strength to get through this. Sometimes I lose sight of my faith but I am sustained by other’s belief in me. I feel comforted when I am with sympathetic people. Depression: I don’t understand why I feel like this. Nothing makes sense. I am preoccupied and lose days or weeks. I don’t care how I look. I am worthless and to blame for this situation. I don’t cry, don’t feel sad. I feel nothing. I have no energy. I am always in a fog. I don’t care about my health. My life is hopeless. I am a broken person. I can find no comfort. I don’t care what happens. I can’t snap out of it. Other’s don’t care. I have nothing to live for.
  19. As we navigate the changes we experience and the sense of loss we have about those changes we move along a continuum, from chaos after the change/loss occurs to a new “normal” or homeostasis. Letting go of what was and accepting what coming into being.
  20. Relationship – if the attachment was complicated or ambivalent then the loss will be more difficult to work through Circumstantial – if the circumstances are not know, suicide, death related to substance use Historical – if you have experienced a number of losses over time or the current loss reminds you of a previous loss Personality – some of us have a greater capacity than others for intense emotions Social – some of us have more extensive support systems, less support is more difficult
  21. Chronic – sometimes when one loss happens after another we do not have time to recover or heal before the next occurs, makes healing harder (ex bone keeps being broken before it has time to heal) Delayed – because of circumstances or personal factors we are not able to experience or work through the loss at the time it occurred, bottling it up and putting it aside for later can complicate our ability to work through it (ex wound has scab over it, hides the infection but it’s still infected) Avoiding – pretending that the loss did not occur, distracting ourselves from grieving, filling the hole left by what was lost in order to avoid the pain (ex pretending the wound doesn’t exist, child’s peek-a-boo game: if I cover my eyes you’re not there).
  22. We are not meant to grieve alone.