Grieving the Death of Addiction

As a systemic therapist, I look at most everything through the lens of relationships. In working with my substance-dependent patients, the analogy of addiction to a drug is no different.

Like a new relationship, at first, the use is thrilling. There’s the high, the intimacy, the butterflies that come from anticipation of time spent together. When that time becomes more frequent, the attachment becomes stronger. Then comes the increased time spent getting high, followed by the isolation, the cravings for the drug, and placing the addiction as the only priority in one’s life. The feeling of love may even be developed.

I wasn’t having an affair with any other person, but Oxy became my best friend. I was in love with it and never wanted to be separated from it.

The dependence continually intensifies, money is spent to excess, and the “relationship” can become a full-time job to maintain. The drug becomes a permanent fixture that will never leave the now-addict. What once was exploratory and fun becomes dependent, shameful, and confining, further polarizing the relationship with addiction from the real relationships with everyone else. “My husband actually thought I was having an affair because of the time spent away from the family. He knew I was lying about something, but he couldn’t figure out what was happening,” a patient once reported to me in explaining her relationship with prescription opiates. “I wasn’t having an affair with any other person, but Oxy became my best friend. I was in love with it and never wanted to be separated from it.”

In my recovery-based work, I personify addiction as means to help my patients understand the severity of their addiction and their need to separate themselves from it in order to progress within their recoveries. In working with these patients in treatment, there is a significant emotional response when they come to understand that in order to move forward in their recovery, they must first say goodbye to the notion of ever being able to have a healthy relationship with their addiction.

This is where the analogy of the death comes into fruition.

Why does the relationship with addiction have to be explained as grieving a death?

Thankfully, relationships with people can be impaired or improved. People can grow and work to resolve problems. Conversely, one may try and get back together with their toxic “ex,” and they may find that the honeymoon stage is transitory and the same underlying problems continue to surface. I equivocate the latter process to a relapse; in order for us to be healthy, we must separate ourselves from the unhealthy. And as morbid as it may seem, comparing the relationship with addiction to a death provides a concrete finality that addicts need in order to reach the stage of acceptance. They must understand that despite how much a part of them loves their addiction and wants a relationship with it forever, their addiction will never be able to reciprocate healthy love in return.

They must understand that despite how much a part of them loves their addiction and wants a relationship with it forever, their addiction will never be able to reciprocate healthy love in return.-Lindsay Kramer

Death in this regard is the symbolization of the ending of a very deep relationship. It’s important to endure the grief process in order to understand the depth of the addiction itself, but to surrender also means to accept the death and move on from it.

How does one go about applying the analogy of grief into addiction treatment?

In working with grief itself, I’ve come to understand that 1.) it [unfortunately] is a lifelong process, and 2.) it endures many stages, several times over. That’s when the Kübler-Ross model (1969) of the five stages of grief comes into the limelight. For those needing a refresher, the stages are Denial, Bargaining, Anger, Depression and Acceptance. When applying this analogy of grieving the death of addiction, I explain and process each stage with my patients in order for us to understand where they are in their overall recovery.

• Denial: This is addiction in its active stage, and there is difficulty in acknowledging that the consequences of maintaining this relationship outweigh the benefits of the relationship itself. Denial may present as the addict not wanting to surrender the relationship due to fear of change, fear of suffering, and/or fear of “doing the work” involved in the grieving (i.e. recovery) process.Denial in this stage appears as taking the stance of the problem being everyone else’s and not of their own. “I’ve got this handled; I can manage it on my own.” The addict is not yet connected to the toxicity of this relationship and will defend it to others. A common stance in this stage may be, “why would it hurt me?” Perhaps, the addict is aware of the pain that the relationship has caused to others, but they are still in disbelief that it would ever cause pain to him/herself.

In this stage, the addict is desperate to demonstrate to everyone else that the relationship is not toxic by attempts to prove that ‘things will be different this time’…-Lindsay Kramer

• Bargaining: This is an area in which relapses can occur, if any sobriety has been achieved. The addict attempts to bargain with recovery by means of “only just having a few drinks,” trying to maintain friendships with using friends, or by not declaring one’s sobriety to others in attempt to minimize the severity of their addiction. “I didn’t tell anyone I was sober outside of the people in my meetings, and I ended up relapsing several weeks after I got out of treatment,” is a common declaration from patients in this stage after they return to treatment.In this stage, the addict is desperate to demonstrate to everyone else that the relationship is not toxic by attempts to prove that “things will be different this time,” or that they “can control it this time.” The addict may even blame others for why the relationship isn’t working, and may displace emotional reactivity onto those that attempt to separate him from his use. This is the stage where the addict realizes that the addiction is not within their control, however they are persistent in their attempts to demonstrate any shred of control that they have over this relationship.

• Anger: This is the stage in which the addict becomes angry at the clarity that this relationship is toxic, has caused them pain, and cannot be controlled. The anger is experienced at the awareness that the addiction has lost them jobs, cost exorbitant amounts of money, ended healthy relationships, and has ultimately caused them much pain. The addict may be angry at feeling abandoned and betrayed by the addiction, despite how they had tried to defend it early on in the relationship.As I strongly believe that anger is a secondary emotion which blankets our deeper pain and motivates us to take action, anger can be projected onto the relationship itself, or onto oneself for allowing the addiction to cause such immense damage. In this case, the addict experiences being angry toward the addiction and much more toward themselves, causing a frenetic urge to take responsibility and action away from the relationship.

• Depression: Aside from the chemical depression resulting from the recalibration of the Hedonic Set Point (Brickman & Campbell, 1971), depression is likely the primary emotion covered by anger, and takes many forms in this stage. This is where the addict may experience sadness over the awareness of the wreckage that was caused by the addiction. “I became very sad once I realized how I let the addiction treat me and how it abandoned me,” one patient expressed. There may also be depression at the realization of how the addict has treated themselves in the course of their addiction.In this stage, the addict may become depressed due to the realization that they aren’t ever going to be able to drink/use again and that they do have to say goodbye to their relationship once and for all. Depression sets in about the idyllic thought of not being able to enjoy a glass of champagne at a wedding, use more responsibly like they did in the earlier stages of the relationship, and/or over the fact that their recovery is one they will have to manage every day for the rest of their lives. Depression may also be felt over the realization that this traumatic relationship is one that may have to be re-experienced daily in order to prevent the addict from returning to the relationship.

  Depression is akin to acceptance, but differs by deeper emotional responsiveness when the addict in recovery finally begins to grieve the loss of this relationship.

Acceptance is vocalizing the understanding that this relationship is a disease that will only continue to kill them if they continue to keep it alive.-Lindsay Kramer

• Acceptance: This is the triumphant stage in which the addict in recovery accepts the loss of their relationship and begins to apply the conceptualization of living life free from addiction. This is the stage in which the recovered readily acknowledge that the fantasized wedding champagne toast could lead to a DUI following the reception, that the hangovers were exponentially worse than the highs, and that they want to experience lasting, healthy relationships in the future. Acceptance is vocalizing the understanding that this relationship is a disease that will only continue to kill them if they continue to keep it alive.Acceptance takes form as surrender, as freedom, and as the choice that the recovered make in order to say goodbye to this relationship forever. In my experience, those that reach this stage are active in their recoveries and go on to assist others in earlier stages of this grieving process. The recovered that have accepted the death of their addiction go on to lead lives that are not without struggle, but the most important change is that they are now able to lead their own lives again.