Grief & Addiction: Everything You Need to Know

October 17, 2022

Table of Contents

Grief and addiction are often connected.

For some people, a loss sparks substance misuse. For others, death worsens a pre-existing substance misuse issue. And for many, addiction complicates recovery from grief.

It's impossible to prevent death and loss; grief is a universal part of the human experience. Yet it can also be a strong trigger for new or worsening substance misuse.

But treatment can help you to address your addiction. As you recover, you'll feel more empowered to manage your grief in a healthy way.

What Is Grief?

Grief is a natural, expected emotional reaction to loss. When someone we love dies, whether that's a person or a pet, we notice the absence every day.

Grief can trigger the following:[5]

  • Psychological distress
  • Separation anxiety
  • Confusion
  • Longing 
  • Romanticizing the past
  • Fears about the future

Many people experience grief. In one study, close to 60% of Americans were grieving the loss of someone close to them who passed away within the three years prior.[6] Almost everyone you know is mourning someone, whether they show visible signs of grief or not.

While grief may be common, some people experience complicated grief. This difficult emotional state is associated with the following:[7]

  • Major loss: A significant other, such as a spouse, dies. 
  • Separation distress: The person left behind feels intense anxiety about life without the loved one. 
  • Symptoms: The person shows cognitive, emotional, and behavioral symptoms triggered by grief. 
  • Length: The issue persists for six months or longer after the death. 
  • Struggle: The person is impaired by the grief and can’t do things that once came naturally.

Up to 20% of people who experience a loss develop “complicated” grief.[7] 

What Are the 5 Stages of Grief?

In 1969, researcher Elisabeth Kubler-Ross created a grief framework to help people understand common reactions to loss.[8] While people may have individual experiences that don't fit this model, understanding the five stages could help you know how your reactions fit in with those experienced by others. 

Stage 1: Denial

Initial shock and disbelief can cause people to initially not believe that someone has died or is going to die shortly. This is referred to as “the denial” stage. They may believe or make unrealistic statements that the person is “going to get better” despite the evidence to the contrary. 

Stage 2: Anger

After denial often comes a period of anger, where the individual may lash out at others - justifiably or unjustifiably. They may blame medical professionals involved in the person’s care, or other friends or family. 

Stage 3: Bargaining 

After anger, some people display “bargaining” behavior. They may say, well if I just do this, maybe the person will come back or be ok. 

Stage 4: Depression

After denial, anger and bargaining, the reality of the situation often hits, and people experience classic symptoms of depression and sadness. This can last for days, weeks, months or even years. 

Stage 5: Acceptance

Hopefully, we eventually come to terms with the loss. While we may never be truly happy about the loss, we accept that this is how life works right now. We approach our remaining pain with compassion.

In “complicated” grief, people get “stuck” at one of the earlier phases and are unable to reach acceptance. At these earlier stages, people may turn to drugs or alcohol as a coping mechanism. 

4 Key Statistics About Grief & Addiction

Each person's grief and loss are unique. But these statistics do reflect some of the more common phenomenon we see with grief and substance use:

1. Two Times More

Women who lose a child are two times more likely to die of an alcohol-related issue when compared to their peers.[1] This study shows how some people use substances like alcohol to treat their grief after a significant loss. 

2. More Than 100,000

In a 12-month period, 100,306 people die due to a drug overdose in the United States.[2] Many people who use substances have friends or family members who have overdosed from drug use. Survivors may turn to substances themselves to address their loss and grief. 

3. Five Years After

Young people who experience a death are more likely to develop a SUD in the following five years when compared to peers.[3] Drug use at younger ages is associated with persistent SUDs that come with ingrained patterns that are hard to break. 

4. Close to 35%

Evidence shows that individuals using substances may actually be at risk for experiencing longer or more severe grief reactions: In a study of bereaved men, 34.2% with SUDs had complicated grief, compared to 5% without SUDs.[4] Both groups experienced a loss, but the substance use made the healing process longer and harder.

What Role Does Grief Play in Addiction?

Addiction and grief go hand in hand. The relationship is complicated, and it can change over time. But in general, addiction and grief intersect in two main ways.

Starting an Addiction 

Trauma is a well-known substance misuse trigger. People turn to drugs and alcohol to cope with negative feelings left behind, and before long, the issue spirals out of control. 

For example, losing a parent before reaching age 18 has been shown to increase the risk of a subsequent prescription drug use disorder.[9] Some young people don't seem to recover from losing a parent at such an early age.

But adults can also develop an SUD in the aftermath of a very difficult loss, including the death of a child or a spouse. 

Prolonging Grief

“Complicated” grief is more common among people with SUDs, especially if the misuse began before the loss.[10] When people enter the grief process with an already present substance use disorder, it can worsen mental health and reduce effective coping. A loss that's already difficult could be even more so when mixed with substances. 

5 Common Events That Lead to Grief & Substance Misuse 

Any loss could trigger feelings of grief. This list isn't meant to validate some sorts of loss above others. All feelings are valid.

But these are the types of losses researchers tie closely to grief complicated by substance misuse:

1. Death of a Parent

In a study of adolescents, bereaved participants had higher rates of substance misuse than their peers, and they started using drugs earlier than their peers.[3] Losing a parent was traumatic for these young people, and they turned to substances for relief. Adults may also face complicated feelings when their parents die, but the relationship between grief and addiction is strongest in adolescents who lose a parent. 

2. Death of a Sibling

In a study of substance misuse among people who are grieving, researchers found that losing a sibling is one of the most traumatic types of loss. The highest rates of complicated grief were found in those who lost a sibling.[11]

Losing a brother or sister can remind people of their own mortality. And in some families where siblings are close, brothers and sisters represent the loss of a major support in a person’s life.

3. Death of a Spouse or Significant Other

Husbands, wives, and partners are often our closest confidants. We share many of the same experiences, and among people with substance use disorders, some couples share their drug habits. Losing a partner to drugs or alcohol can be devastating to the person left behind. [12]

4. Death of a Child

A loss of a child, at any age, is one of the worst traumatic events a parent can endure. Even when children are older and grown, their deaths can deeply traumatize the parents left behind. In a study of parents who lost their sons in a military training accident, about half of all participants had some kind of psychiatric disorder.[13] Some developed SUDs.

5. Traumatic Deaths

Some deaths are expected, and while they're painful, they're less surprising. Others happen suddenly or due to an unexpected issue. Traumatic or unexpected deaths are closely associated with grief and addiction. In a study of people who lost loved ones to homicide, for example, 8% reported misusing substances after the loss.[14]

Treatment Options for Grief-Informed Addiction 

SUDs are treatable, even when they're complicated by grief. People struggling with these issues need comprehensive programs that combine multiple elements to deliver real results. A program might include these types of solutions:

Counseling

As a first step, counselors encourage grieving people to talk about the loss.[15] Therapy approaches like this are validating and encourage people to understand that their feelings are both real and understood.

Counselors might also explain how substance use disorders intersect with grief, and they might help patients to identify their substance misuse triggers. With that understanding, people can develop new coping strategies outside of substances. 

Support Groups

Poor social support is associated with complicated and enduring grief.[16] A grief-focused support group allows people to find peers who understand what they're feeling and how they're coping. For some people, this is the first time they've been surrounded by others who might understand and listen. This support can make a big difference in their recovery.

Medication for SUD

Recovering from grief is hard work, and people need a clear mind to participate in both counseling sessions and support groups. Medication can help. Medication for Addiction Treatment (MAT) can curb withdrawal feelings and ease cravings for substances so that a person can focus on their recovery and healing from their grief.

If you are concerned you may be experiencing “complicated” grief and are noticing new or escalating use of substances in relation to that grief, it might be time to reach out for help.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Alcohol-Related Mortality Following the Loss of a Child: A Register-Based Follow-Up Study From Norway. BMJ. https://bmjopen.bmj.com/content/10/6/e038826. June 2020. Accessed September 2022.
  2. Drug Overdose Deaths in the U.S. Top 100,000 Annually. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20211117.htm. November 2021. Accessed September 2022.
  3. Alcohol and Substance Abuse in Parentally Bereaved Youth. Journal of Clinical Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4037812/. August 2014. Accessed September 2022.
  4. Is Complicated Grief a Risk Factor for Substance Use? A Comparison of Substance Users and Normative Grievers. Addiction Research and Theory. https://www.tandfonline.com/doi/abs/10.1080/16066359.2017.1285912?journalCode=iart20. February 2017. Accessed September 2022.
  5. Grief. American Psychological Association. https://dictionary.apa.org/grief. Accessed September 2022.
  6. New WebMD Report: Grief is Universal, Yet Responses From Others Often Unhelpful. PR Newswire. https://www.prnewswire.com/news-releases/new-webmd-report-grief-is-universal-yet-responses-from-others-often-unhelpful-300883142.html. July 2019. Accessed September 2022.
  7. Caring for Parents After the Death of a Child. Pediatric Critical Care Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082144/. August 2019. Accessed September 2022.
  8. The Stages of Grief: Accepting the Unacceptable. University of Washington. https://www.washington.edu/counseling/2020/06/08/the-stages-of-grief-accepting-the-unacceptable/. June 2020. Accessed September 2022.
  9. Childhood Family Characteristics and Prescription Drug Misuse in a National Sample of Latino Adults. American Psychological Association. https://psycnet.apa.org/buy/2017-17890-001. August 2017. Accessed September 2022.
  10. The Relationship Between Substance Misuse and Complicated Grief: A Systematic Review. Journal of Substance Abuse Treatment. https://www.journalofsubstanceabusetreatment.com/article/S0740-5472(18)30574-9/pdf. May 2019. Accessed September 2022.
  11. Is Complicated Grief a Risk Factor for Substance Use? A Comparison of Substance Users and Normative Grievers. Addiction Research and Theory. https://www.tandfonline.com/doi/abs/10.1080/16066359.2017.1285912?journalCode=iart20. February 2017. Accessed September 2022.
  12. "Nothing to Mourn, He Was Just a Drug Addict." Stigma Toward People Bereaved by Drug Death. Addiction Research and Theory. https://www.tandfonline.com/doi/full/10.1080/16066359.2021.1912327?src=recsys. May 2021. Accessed September 2022.
  13. Parental Mental Health After the Accidental Death of Son During Military Service. The Journal of Nervous and Mental Disease. https://journals.lww.com/jonmd/Abstract/2012/01000/Parental_Mental_Health_After_the_Accidental_Death.10.aspx. January 2012. Accessed September 2022.
  14. Review Into the Needs of Families Bereaved by Homicide. Louise Casey. https://www.justice.gov.uk/downloads/news/press-releases/victims-com/review-needs-of-families-bereaved-by-homicide.pdf. July 2011. Accessed September 2022.
  15. The Many Victims of Substance Abuse. Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880942/. September 2007. Accessed September 2022. 
  16. Effects of Bereavement Groups: A Systematic Review and Meta-Analysis. DeathStudies. https://www.tandfonline.com/doi/full/10.1080/07481187.2020.1772410. June 2020. Accessed September 2022.

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