In 1969, Elizabeth Kübler-Ross described the five stages of grief. In my experience, these also characterise aspects of confronting “substance use disorder”. Keeping these in mind also helps us to build recovery treatment for those suffering from addiction.
Grief, of course, is triggered by many different situations – bereavement, a broken relationship, terminal illness or loss of a job, for example. We experience many of these at various stages in our lives. How we cope partly defines the person we become. I suffered grief with my family when my brother died. I’ve mentioned this several times in my blogs. In fact, I’m coming to realise that it’s played a bigger part in my drinking than I’ve previously acknowledged (see The Divided Mind).
It seems to me completely legitimate to apply a model of the outworking of grief to addiction. Here we are considering not the specific event or trigger of grief, though trauma plays a major part in the addiction literature. Instead, we are talking about a process. That is because in turning around we acknowledge that there are common stages of experience and behaviour.
The first stage is Denial. This is very common for addicts. We try to carry on as though nothing has happened. I’m not sure this is a coping mechanism, as such. Rather, it’s the fact that we refuse to acknowledge that the repeated cycles are indicative of loss of control. More generally, we also refuse to acknowledge the damage to ourselves and to others.
Why do alcoholics and others with addictive disorders stay in denial? I think it’s partly because we see it as failure in ourselves. We don’t want to admit to what we believe others will see as weakness. We don’t want others to think that we can’t cope without the help of others. In my experience of reaching out or being available as a mentor, it’s by far the major stumbling block in persuading others to engage with me.
The second stage is Anger. Nobody likes to be told they’ve got it wrong. Nobody likes to be told that they’ve got a problem which needs to be addressed. This, of course, goes hand-in-hand with denial. It’s why we need to be extremely careful when approaching alcoholics with an offer of help. If you’re not careful then you’ll be told to go away in not very polite language – to mind your own business, basically. It needs to be done with care.
Anger is also the manifestation of a frustration within the addict confronted by his or her circumstances. Why does this happen to me and not somebody else? What have I done to deserve this? Why does everybody else seem to think the problem lies with me? Why does everybody seem to believe it’s my fault? We don’t, of course. But we’d like to help you get to the bottom of it and see what we can do together to help you turnaround.
The third stage of this model is Bargaining. I’m not entirely sure how this applies to grief. With regard to addiction, I see it as part of the repeated cycles of attempts to get the usage disorder under control. This is an attempt to convince both yourself and others that you can cope. Examples of bargaining include – I will only drink at the weekend, I won’t drink spirits, just let me drink occasionally and I’ll keep it under control is basically the plea. I tried all of these many times!
The fourth stage is Depression. You can’t do it on your own. This is a collapse inward. This for me is the stage at which there is a realisation of the seriousness of the situation. The denial, the anger and the failed bargaining have seen some people drop away leaving you alone with the underlying problem unaddressed. You are still locked into destructive behaviour. It hurts but you are running out of options. Understandably, the mood blackens, only worsening the self-destructiveness.
The fifth stage, finally, is Acceptance. Having experienced a sense of shock and loss in life, this is the stage at which the emotional response to the situation is calmed down. It really happened, there is no going back, it’s time to face the facts and move forwards. I’ve seen this at the turning point of many alcoholics. It’s the time at which resentments go. Basically, we are laid bare, broken in humility, and ready to respond. I was ready to do whatever it took to get well again.
Here I would add confession. We have talked about this before (see Confession and Memory – Write It Down). It’s the time to talk. We are done with the denial and the raging. Finally, we accept our situation and we are ready to talk about it openly and freely. This helps us to get so far but is incomplete.
Acceptance and confession are the important first steps in any recovery programme. But we need more. As said in previous blogs, acceptance and confession are cleansing. This marks a turning point. The task at this stage is to use that opportunity to build upon the foundation stone. Hence we need to go beyond the five stages of grief in building recovery treatment.
This is the stage for reconciliation. This means reconciliation within the divided self and with others. There can be no reconciliation without forgiveness. We need the forgiveness of others and we need to forgive ourselves. Acceptance, confession and reconciliation are restorative or, dare we say, redemptive. We change the way we lead our lives through seeing the world and others through a different lens.
Recognising the parallels with the stages of grief is important in addiction treatment. We are on a journey but, importantly, this is only the first part of recovery – onwards and upwards!