The disruption to our lives, our families and our businesses from COVID-19 has left many of us with an overwhelming sense of loss - loss from our normal routines, loss of our jobs, trying to keep our businesses and income alive, seeing our friends and families, and going out to the places we enjoy. Others have had to overcome sickness or are grieving the loss of loved ones. Our lives are different now – and so much of what we expected has changed. We are resharing this blog, originally published in 2019, about the importance of addressing loss and grief. The extenuating circumstances we all face today make protecting our mental and physical health even more critical. We will be discussing more about managing loss and grief in the coming weeks.
Grief and loss are two of the primary drivers behind drug addiction and the stages of alcoholism. For example, widowers over the age of 75 have the country’s highest rate of alcoholism. It’s a problem we often see in Caron’s Older Adult Program.
But grief and loss are universal. Everyone deals with loss in their lives -- and it can come at any age. We often think of grief and loss as involving a death, but similar emotions can be experienced any time there is a significant life change. Retirement, for example, can leave a person feeling bereft at the loss of the comradery at work and the sense of purpose that comes from a career.
As people get older, they will lose friends and loved ones to death, but they may also experience the loss of health and independence. Medical issues and a general decline in physical and mental faculties means they may no longer be able to do the things that previously brought them joy and purpose. When their world shrinks, it can be devastating to their mental health.
Research shows there are different stages of grief that people move through as they process a loss. Some people get stuck in the grieving process, which may cause problems, even years afterwards. Some of the signs that someone is having difficulty coping with grief and loss include:
- They may become withdrawn and isolated. They don’t want to be around family, stop calling friends or going out with people. They seem to lack the energy to socialize or participate in activities that they once loved.
- They are overwhelmed, moody, sad or listless. They lack the patience they once had and are more prone to angry outbursts. They may appear sad and have crying spells.
- They sleep a lot, or they can’t sleep. Anxiety and depression may disturb a person’s sleep cycle. This lack of restorative sleep can exacerbate untreated anxiety and depression and make them lethargic.
- They stop taking care of themselves. Their hygiene starts to decline, and they may not bathe as frequently. They don’t dress as neatly as they usually do or seem to not care about their appearance.
- They get sick more often. Untreated grief and loss can lead to depression, which can lower one’s immune system.
- They develop chronic pain. Emotional pain can manifest as physical pain.
Echoes of unresolved trauma
Someone who has difficulty processing a loss may also be struggling with hidden and unresolved trauma that can go as far back as early childhood. Perhaps they’ve been self-medicating with substances or coping in some other manner, but the latest loss has upset their equilibrium and accelerated their substance use.They might not even realize it, and it may not come to the surface until they’re in treatment. There may not be one specific traumatic event in their past, but potentially a series of repeated traumas, such as physical, verbal or emotional abuse growing up, or simply an unhealthy or chaotic upbringing. They didn’t have the opportunity to learn the healthy coping skills needed to deal with everyday stress and loss, because it wasn’t modeled for them growing up.Consider a situation where someone’s father left when they were a child, and they never fully grieved or processed that loss. Now, late in life, they are going through their own divorce. These early events and memories are compounded emotionally.Children, when they’re young, may internalize the fallout of a traumatic family event and develop maladaptive beliefs about themselves if they don’t have emotional support to process the experience. For example, during a divorce, some children might develop a belief that other people will always leave them. Continuing to view the world through this maladaptive lens -- that everyone will eventually abandon them -- may lead to depression and anxiety, particularly when that belief is brought to the forefront by a recent loss.Now, imagine this same child, 50 years later, when their spouse passes away. A person with that childhood history may deal with the loss of their spouse quite differently than someone who had a healthier upbringing. These vulnerable older adults often turn to substances as a way to cope.
Is it depression, or is it addiction?
As part of our comprehensivetreatment at Caron, we evaluate every patient to understand the role that issues such as grief and loss and early traumatic experiences played in their substance use. When people get stuck in the grieving process, normal healthy grief shifts to persistent bereavement or even a depressive disorder. We address these problems using multiple treatment modalities, including cognitive behavioral therapy, where we help patients identify core beliefs about themselves that contribute to unresolved grief, depression, anxiety, and substance use.
We teach them skills and strategies to shift negative and distorted thoughts about themselves, the world, and other people. This new way of thinking has a trickle-down effect, allowing them to feel better emotionally and extinguish self-defeating behaviors, including substance use.
Our goal is that older adults can rekindle a sense of purpose and quality of life. Instead of their world shrinking, in recovery, it begins to grow.
By Ming Wang, MD, FASAM