Grief, Trauma, and Substance Abuse

Grief, trauma, and substance abuse are deeply connected experiences that often overlap and reinforce each other. That was the case for Howard and Greta. Howard began drinking heavily after experiencing a traumatic loss. His brother, to whom he was very close, suicided. It happened suddenly with no warning. Making things worse, Howard was the one who found his brother dead on a visit to his brother’s apartment.

Greta watched Howard sink into a downward spiral and became more and more alarmed. Each time she brought up the issue of his drinking, it turned into a prolonged and vicious fight. She also saw that as Howard continued to drink over time, he put off dealing with the loss which had so traumatized him.

Where there is significant pain, anguish, or discomfort, there is usually also a deep desire to find relief. Alcohol and drugs can provide that relief, at least temporarily. Unfortunately, once their effects have worn off, the pain will still be present and may even feel worse. So, the desire to drink or use again may become even greater. This is what happened to Howard and it became a challenge for Greta. She felt beside herself, not knowing what to do and quickly realized that discussions quickly turned into fights.

How Grief, Trauma, and Substance Abuse Are Connected

1.  Grief

Grief is a natural response to loss—this could be the death of a loved one, the end of a relationship, loss of identity, getting laid off from a job, or even missed opportunities. While painful, grief itself isn’t a disorder. But when it’s overwhelming or prolonged, it can become harder to cope with. The fact is that grief has no timeline and may remain acute for a long time.

The best outcome may be that the grieving person finds a way to accept the loss and its accompanying pain while returning to living as fully as possible. This can take a while and often involves significant effort. Howard’s use of alcohol is particularly problematic because it interferes with his ability to understand and manage his grief and undermines his development of coping skills.

2. Trauma

Trauma happens when an experience is so distressing that it overwhelms a person’s ability to process it. This could include abuse, violence, accidents, or sudden loss. Trauma can change how the brain processes fear, memory, and safety, sometimes leading to conditions like Post-Traumatic Stress Disorder. In essence, trauma turns on danger signals in the brain and body that don’t shut off. So, the traumatized person is continually experiencing fear, anxiety, or discomfort in the expectation that something bad is about to happen or is happening. It doesn’t matter if things seem neutral or safe to an outside observer. To the traumatized person, the inner experience of potential danger is as real as his or her next breath. Howard lives with this sense of persistent dread and feeling of impending danger. In large measure, that is what his drinking “medicates.”

3. Substance Abuse

For Howard, substance use began as a way to cope—trying to numb the emotional pain, quiet intrusive thoughts, and escape overwhelming feelings. This kind of coping becomes maladaptive over time because it merely shuts down feelings instead of helping Howard to face and deal with those feelings. Plus, regular use of alcohol or substances can develop into dependence or addiction, making things more complex. As with alcoholics in general, Howard’s continued heavy drinking will eventually make drinking less about dealing with uncomfortable emotions and more about preventing the sickness of withdrawal.

The Cycle

In short, Howard’s case illustrates how a cycle of grief or trauma and substance use can develop:

• Grief and/or trauma creates intense emotional pain

• Substances are used to cope or escape

• Substance use can worsen mental health, increase isolation, or create new problems

• This leads to more grief (e.g., damaged relationships, lost opportunities) and deeper trauma

• This, in turn, spurs on more substance use

Paths Toward Healing

Recovery is possible, both for Howard individually and for Greta and Howard as a couple, if they are willing to address all three areas together: grief, trauma, and substance abuse.

1. Therapy

Howard would likely benefit from approaches to help him deal with his substance use, his grief over his brother, and the trauma associated with his brother’s suicide. Trauma Focused CBT, Accelerated Resolution Therapy (ART) or Eye Motion Desensitization and Reprocessing (EMDR) can help Howard grapple with theses painful and overwhelming experiences. Eventually, couples therapy for Howard and Greta may help them find ways to communicate and repair the damage that has been done to their relationship.

2. Medical Support

Detox and withdrawal from alcohol can be both severe and dangerous. So medically supervised withdrawal may be necessary for Howard if he is to stop drinking. This can involve the use of medications to manage severe symptoms. It can also involve a stay in a rehab facility to allow for medical supervision, administration of appropriate medications, and monitoring of the patient’s emotional and psychological well-being.

3. Support Systems

Support groups (like those through Alcoholics Anonymous or grief groups) can reduce isolation and provide understanding. For Howard, the knowledge that he is not alone in dealing with his recovery from alcohol and the horror of his brother’s suicide may provide a much-needed boost. Group members can help him normalize his experience and not feel so alone. For Greta, support groups for partners of alcoholics may help her get clarity about how to take care of herself and what she can and can’t do for Howard.

4. Healthy Coping Skills

As a recovering alcoholic and survivor of a brother’s suicide, Howard would benefit from learning more effective coping skills. For him, knowing how to accept difficult emotions and find constructive ways to deal with stress is essential. The following are examples of coping skills that may help him accomplish this:

• Exercise

• Journaling

• Mindfulness or meditation

• Creative outlets

But even with solid coping skills, healing isn’t linear. Howard might feel like he’s making progress and then suddenly struggle again—that’s normal. What matters is building safer ways to cope and having support while doing it.

What Can a Partner Do?

Partners are in a tough position because they need to take care of themselves while being honest and setting appropriate boundaries with the substance user. For Greta this means finding a way to balance honesty, caring about Howard, and keeping within her own limits at the same time. Greta, like all partners of substance abusers, needs to get clear on what she can and can't do for Howard.

1. Start with the right mindset

For starters, Greta must realize that she’s not there to “fix” Howard—in fact, she does not have the power or ability to do so. Instead, she needs to try to connect, understand, and support. Change usually happens slowly, and only if Howard feels safe rather than judged will he be able to start thinking about doing what’s necessary to change

2. Lead with empathy, not accusation

Accusations immediately put the accused person on the defensive. For Howard, accusations activate both the shame he experiences about his drinking and the dread and anxiety that arise from his trauma. Greta may have more success being heard if instead of saying: “You’re drinking too much” she says: “I’ve noticed you’ve been hurting a lot, and I’m really concerned about you.”

This keeps the focus on Howard’s pain, not just his behavior.

3. Acknowledge the grief and trauma directly

Howard may feel unseen in his pain, or he may feel like his pain is somehow not valid. If Greta can acknowledge this, it may help Howard to accept what he’s going through:

• “What you went through was really heavy.”

• “I can’t fully understand, but I want to.”

Because it is likely that trauma is involved for Howard, validation is powerful because he may mistrust or doubt the reality of his own feelings. Validation means that someone else acknowledges the truth of his experience.

4. Talk about substance use without shame

Substance use is often a coping mechanism, not the root problem.

• “I get why you’d want to escape how intense this feels.”

• “I’m worried the drinking is making things harder for you.”

Not labeling Howard (“addict,” “messing up”) makes it less likely that he will shut down.

5. Set boundaries (this is just as important)

But supporting Howard doesn’t mean Greta should tolerate harmful behavior. She can set limits by saying:

• “I care about you, but I can’t support things that hurt you or us.”

• “I need us to find a healthier way through this.”

Boundaries protect both Howard and Greta and actually make long-term support possible.

6. Encourage help—but don’t force it

Greta can open the door:

• “Would you be open to talking to someone together?”

• “We could look into support groups like Alcoholics Anonymous or therapy.”

But pushing too hard can create resistance in Howard. Greta must think of it as planting seeds.

What to avoid

There are some things that Greta should avoid because they will shut Howard down and bring her more pain:

• Lecturing or trying to “logic” Howard out of pain

• Ultimatums (unless safety is at risk)

• Taking Howard’s behavior personally (even though it affects her)

• Ignoring her own emotional limits

A helpful frame

The most helpful framework Greta can adopt is as:

• A steady presence, not a rescuer

• A listener, not a fixer

• A partner, not a therapist

Loving someone through this can be exhausting. Greta may need her own support too—friends, therapy, or groups for partners of people dealing with addiction and trauma.

At EMDR Associates, we can assist in cases of family conflict involving grief, trauma and/or substance use. We provide a safe place to get in touch with your feelings, help you reframe unhelpful ideas about yourself and your partner, assist with structuring constructive conversations, and work with you to develop healthy and clear boundaries. We are experts in recovery from substance dependence and addiction. Give us a call to start your journey to a healthier way of life.