Grief and loss go hand in hand. While grief is experienced in a multitude of ways and doesn’t look the same for any two people, it is universally recognized that when a person you care for dies, there is typically grief that accompanies that loss. However, what is perhaps less regularly acknowledged are the variety of losses that people with substance use disorder and their loved ones might be facing on an ongoing basis.

September is National Recovery Month, and a time to reflect on the necessity of grief management for anyone navigating the recovery process. Grief and substance use are often related, with many people turning to substance use to cope with or mask their grief. While using, many people experience the loss of friends and acquaintances from drug-related deaths or suicide. They often become estranged from some family members or friends, or find their once-stable relationships changing or becoming rocky. Substance use disorder may lead to other losses, including separation or divorce, loss of custody, loss of a job, loss of financial stability or even the multitude of losses that can come from incarceration.

It’s not uncommon for people in recovery to also experience grief over what are ultimately positive changes in their life. Individuals recovering from substance use disorder may encounter grief over the loss of their substance of choice and the role it filled as a coping mechanism. The recovery process can also mean moving away from a specific community or lifestyle, ending certain friendships or letting go of favorite activities or places. While these may all be steps in the right direction, it’s completely natural to feel grief over the loss of any of these elements that had become a routine part of life.

Family members and friends of people with substance use disorder experience grief in their own ways. Ambiguous grief can appear when someone is grieving a person who is alive, but has changed. It’s normal to long for the person they were prior to substance use, or to experience ambiguous grief over the uncertainty of the situation. They may be estranged from their loved one or may have had to alter their relationship, perhaps setting necessary boundaries that result in less availability to see their person. Loved ones may also experience anticipatory grief when worrying about their person becoming incapacitated, imprisoned or dying because of their substance use. These forms of grief can be isolating and often come with feelings of guilt for grieving someone who is alive – but it’s completely normal to feel this way.

When someone dies because of a drug-related occurrence, loved ones are often left with disenfranchised grief. These deaths are highly stigmatized, often leading people to feel like they don’t have the right to grieve this loss, or even feeling pressure from others or society to not honor their grief. Disenfranchised grief causes feelings of isolation and guilt, as well as anger, which might be directed toward the person who died, the situation in general or even society for failing their person. If there has been estrangement or friction in the relationship, loved ones may struggle with even more intense grief after death.

Whether you are experiencing grief alongside substance use disorder, or you are grieving because of a loved one’s substance use disorder, it is important to seek support for your specific needs. A quality rehab program should include grief education and support. Loved ones may find that a support group like Al-Anon or Alateen is helpful when coping with substance use disorder, and substance-related death bereavement groups can bring together people who might be grieving similar losses.

As a society, we have work to do in speaking more openly about both grief and substance abuse. Despite the heavy impact each has on so many individuals, they are often taboo subjects when in reality, getting support for both is an important part of leading a healthy lifestyle.

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