There is a multitude of different sources of grief and loss, and clients in AOD settings are often highly likely to experience these emotions for a variety of reasons. Feelings of grief or loss are often associated with traumatic experiences. It is also common for AOD clients to have lost partners, family members, or friends as a result of AOD use. Receiving treatment for AOD issues is likely to cause feelings of loss due to the heavy role AOD use plays in the client’s life [389, 1585]. Other tangible losses may include the loss of relationships, employment, finances, identity, spiritual beliefs, and physical health, but a person may also experience intangible losses such as loss of hope, dignity, identity, self-worth, trust, or values [389, 1586].
Clients experiencing grief may report symptoms similar to those of major depression, such as sadness, tearfulness, difficulty sleeping, and decreased appetite. However, it is unlikely that clients experiencing feelings of grief and loss would also experience the cognitive symptoms of depression, such as feelings of guilt, hopelessness, helplessness and worthlessness [1587]. Also, while some people impacted by grief and loss may express a desire to be reunited with a lost loved one, they generally do not experience the persistent suicidal ideation that may be experienced by some people with major depression. Nevertheless, as discussed in Chapter B4, continued assessment should be undertaken, as well as a thorough risk assessment for any client who may be at increased risk of suicide, as major depression may develop following grief reactions.
Symptoms of grief and loss fall into a number of categories including [389, 1585, 1588]:
- Emotional – feelings of shock, numbness, disbelief, loss of control, fear, panic, confusion, anger, sadness, guilt, desire to blame, or hostility. The person is likely to fluctuate between different emotional states.
- Psychological – in addition to these emotions, clients may also have a preoccupation with the deceased, or a sense of the presence of the deceased. Temporary cognitive impairments are also common (e.g., concentration and memory complaints).
- Physical – gastro-intestinal complaints, decreased sex drive, tension, headaches, sleep/appetite disturbances, fatigue, lethargy, or depersonalisation/dissociation.
- Behavioural/social – inappropriate behaviour (e.g., laughter), social withdrawal, avoidance of objects or people related to grief/loss, sighing, restlessness, crying, absentminded behaviour, obsessive behaviour, or hyperactivity.
The above symptoms are all normal responses to grief that tend to dissipate as a person adjusts to the loss over time. For some people, however, these symptoms may persist for an extended period and significantly impair their ability to function. In recognition of this experience, the most recent edition of the DSM has introduced the new diagnosis of prolonged grief disorder. Prolonged grief disorder is characterised by an intense longing for the deceased person or a preoccupation with thoughts and memories of the person alongside other grief-related symptoms that occur most of the day, nearly every day. Grief-related symptoms experienced as a result of the death include identity disruption (e.g., feeling as though part of oneself has died); a marked sense of disbelief about the death; avoidance of reminders that the person is dead; intense emotional pain; difficulty reintegrating into one’s relationships and activities (e.g., problems engaging with friends, pursuing interests, or planning for the future); emotional numbness; feeling that life is meaningless; and intense loneliness.