Grief and Loss in Addiction and Recovery - September 2012

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“Grief and Loss in Addiction and Recovery” was presented on September 25, 2012; by Janice Firn, LMSW, Clinical Social Worker, University of Michigan Hospital; Matthew Statman, LLMSW, CADC, Dawn Farm therapist and Education Series Coordinator; and Barb Smith, author of “Brent’s World” ( The culture of addiction is rife with experiences of grief and loss for the person with addiction and for family and friends. The nature of these experiences combined with the stigma, shame and general lack of understanding of addiction can make grief and loss associated with addiction exceptionally lonely and difficult to heal from. This program will describe Worden's and Kubler-Ross' theories of grief and grief recovery, losses that the chemically dependent individual and his/her family experience throughout the addiction and recovery processes, and how recovery program tools can help individuals cope with grief and loss. It will include a personal account of addiction-related grief, loss and recovery from a mother who lost her son to addiction-related causes. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see

Transcript of Grief and Loss in Addiction and Recovery - September 2012

  • 1. Grief & Loss inAddiction & RecoveryTheory, Personal Awareness, Grief Reactions, & What Helps

2. Overview Why Talk About Grief? Personal Awareness Grief Theories Grief Reactions What Helps09/28/12 Janice Firn, L.M.S.W., Clinical 2 Social Worker, UofM Hospital 3. Whats the first thing you thinkof when I say the word grief?09/28/12 Janice Firn, L.M.S.W., Clinical 3 Social Worker, UofM Hospital 4. GriefLoss? 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 Physicalresponse to loss09/28/12Janice Firn, L.M.S.W., Clinical 5Social Worker, UofM Hospital 6. Why talk about Grief? Change happens! To live is to experience loss Little deaths Change is InevitableGrowth is Optional. - Walt Disney09/28/12Janice Firn, L.M.S.W., Clinical 6Social Worker, UofM Hospital 7. Why do we feel Grief? Attachment Theory Types of Attachments Secure Avoidant Anxious Ambivalent09/28/12Janice Firn, L.M.S.W., Clinical 7Social 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., Clinical8 Social Worker, UofM Hospital 9. Personal Awareness of Grief & Loss Perception is Key Individual Response Frequency of Exposure09/28/12 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 fasterif you ignore it. Myth: Its important to be be strong in theface of loss. Myth: If you dont cry, it means you arentsorry 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 GriefFact: 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 its 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-RossThe five stages of grief:1. Denial/Shock: This cant be happening to me.2. Anger: Why is this happening? Who is to blame? What should have been done differently3. Bargaining: Make this not happen, and in return I will ____.4. Depression: Im too sad to do anything.5. Acceptance: Im able to exist with what happened.09/28/12Janice Firn, L.M.S.W., Clinical12Social Worker, UofM Hospital 13. Stroebe & SchutDual Process ModelOscillating between a Loss- oriented state and a Restoration-oriented stateLoss-oriented: more emotional work of griefRestoration-oriented: more task-focused grief workAdaptive denial and distraction from the emotional work of grief09/28/12 Janice Firn, L.M.S.W., Clinical 13 Social Worker, UofM Hospital 14. Martin & Doka Grieving Styles: contrasting patterns of grieving andmourning Patterns which are not related solely to gender, but to styleof 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 togender09/28/12Janice Firn, L.M.S.W., Clinical 14Social Worker, UofM Hospital 15. J. William Worden Physiological healing is needed to bring thebody back into physical health this type ofhealing takes time. Similarly, after a loss it takes time to return toan emotional state of well-being. The 4 tasks of mourning are an essential partof the healing process. No specific order, but still must be workedthrough 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 Mourning1.Accept the reality of theloss2.Experience and workthrough the pain of grief3.Adjust to the newnormal; life without whatwas lost4.Emotionally relocate theloss and move forward inlife09/28/12Janice Firn, L.M.S.W., Clinical 16Social Worker, UofM Hospital 17. Accept the Reality To come full face with the fact that your loss is realand will not return, i.e. that immediate reunion orregaining it is impossible. Obstacles: Denying the facts of loss. Denying the meaning of the loss, e.g. It wasnt agood job anyway, or I dont miss him, or Im justas healthy as I ever was. Minimizing the loss. Its not that big of a deal.09/28/12Janice Firn, L.M.S.W., Clinical17Social Worker, UofM Hospital 18. Experience & WorkThrough the Pain It is impossible to lose something or someone youhave been deeply attached to without experiencingsome level of pain. Obstacles: Not allowing yourself to feel. Cutting off your feelings and denying that pain ispresent. Avoiding reminders of the loss e.g., trying tofind a geographic cure by moving to anotherlocation, or travelling09/28/12Janice Firn, L.M.S.W., Clinical18Social Worker, UofM Hospital 19. The New Normal Coming to terms with being without (maybe raising childrenalone, facing future unemployment or handicap, redefinition ofself, etc.).A. External Adjustments : how the loss affects your everyday functioning in the worldB. Internal Adjustments: how the loss affects your sense of selfC. Spiritual Adjustments: how the loss affects your beliefs, values and assumptions about the worldObstacles: Promoting your own helplessness. Not developing the skills you need to cope or to function innew roles. Withdrawing from the world. Refusing to see yourself or theworld differently.09/28/12Janice Firn, L.M.S.W., Clinical 19Social Worker, UofM Hospital 20. Moving Forward To find a place for what was lost that will enable us to remainconnected with them/it but in a way that will not keep us fromgoing on with life. Obstacles: Withdrawal from others and life. Unwillingness to love. Unwillingness to risk; making a vow to never investyourself again. Holding on so tight to the past that youre unable to formnew 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 withoutacute pain. When the tasks of mourning have been accomplished. When one can think of the what was lost withoutphysical manifestations such as crying or feelingtightness in the chest. When one can reinvest his/her emotions into life andthe living. When one can regain an interest in life, feel morehopeful, experience gratification again, and adapt tonew roles. Is there a time limit? 1 year? 4 seasons? 2 years? Itdepends.09/28/12Janice Firn, L.M.S.W., Clinical21 Social Worker, UofM Hospital 22. Grieving is Necessary!Man, when he does not grieve,hardly exists.- Antonio Porchia09/28/12Janice Firn, L.M.S.W., Clinical 22Social Worker, UofM Hospital 23. Normal Grief ReactionsEmotionalPhysicalCognitiveBehavioralSpiritual09/28/12Janice Firn, L.M.S.W., Clinical 23Social Worker, UofM Hospital 24. Grief vs. DepressionGrief is a roller coaster.Depression is dead end.09/28/12Janice Firn, L.M.S.W., Clinical 24Social Worker, UofM Hospital 25. Tensions for FamiliesHopeDespairDenialAcceptanceMeaninglessness MeaningfulnessIndependenceAccepting InterdependenceAmbiguity Certainty of OutcomeMaking PlansExperiencing EmotionsHolding OnLetting GoSpeaking Openly Not TalkingFamily as it WasFamily as it is Becoming 09/28/12Janice Firn, L.M.S.W., Clinical25 Social Worker, UofM Hospital 26. When Grief Isnt Healing Relational Factors Circumstantial Factors Historical Factors Personality Factors Social Factors09/28/12 Janice Firn, L.M.S.W., Clinical 26 Social Worker, UofM Hospital 27. When Grief Isnt Healing Chronic grief Delayed grief reactions Avoiding grieving09/28/12Janice Firn, L.M.S.W., Clinical 27Social Worker, UofM Hospital 28. Grief WORK Grief therapy: goal is not about forgetting butremembering with less pain. Developing adaptive coping mechanisms. Finding meaning. AA and Al-Anon, NA and Nar-Anon = grief work09/28/12 Janice Firn, L.M.S.W., Clinical28 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 tangibleor 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 GrievingListenAcknowledge the uniqueness of griefOffer practical helpMake contact, write a personal noteBe aware of holidays and anniversaries09/28/12Janice Firn, L.M.S.W., Clinical30Social Worker, UofM Hospital 31. Grief heals when it is received by09/28/12Janice Firn, L.M.S.W., Clinical 31Social 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 SeriousIllness, p.41. Al-Anon Dist. 5,, 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. Maciejewski, Zhang, Block, Prigerson, (2010) An Empirical Examination of the StageTheory of Grief, JAMA Stroebe, M., & Schut, H