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Blending Grief Counseling with Substance Use Disorder Treatment

Mark Sanders, LCSW, CADC
Illinois State Program Manager
Great Lakes ATTC, MHTTC, and PTTC

Leaf on water

Clients with substance use disorders face many obstacles on the road to recovery, including losses and unresolved grief. Clients get high and stay high to medicate the pain of current and past losses. Counselors can help by cultivating an  awareness of the client’s losses and the skills to help them with the grieving process.

A partial list of losses that clients with substance use disorders grieve includes:

  • Giving up alcohol and drugs. For many of our clients, alcohol and other drugs have been their most constant companion. Many clients have discovered that spouses will leave you, bosses will fire you, relatives will refuse to accept your phone calls, but the drugs are always there. Many will be unable to let the drugs go until they mourn the loss of the absence of the drug (Sanders, 2011).
  • Unacknowledged losses. These losses include miscarriages and stillborn births. Everyone recognizes the pain that accompanies the loss of a child. Few acknowledge the pain that accompanies the loss of a pregnancy or a baby who dies in utero or during childbirth. These tragedies can be equally as devastating. Rarely does a funeral or condolence card recognize these losses. Many women with substance use disorders have experienced miscarriages, sometimes are exacerbated by drug use (which increases shame). They are often left to grieve these losses alone, unbeknownst to their counselors.
  • Death of a child—Perhaps the most difficult of all losses to grieve. Most people, including counselors, struggle to address this issue.
  • Death of a parent or sibling.
  • Losses that clients blame on their substance use disorder: employment, career, status, housing.
  • Parental abandonment.
  • Having children placed in the child welfare system due to parental substance use disorders.
  • Separation and divorce. Many people who have experienced divorce describe it as being closely akin to death. Active substance use disorders increase the risk of separation and divorce.
  • Unspeakable deaths: the losses that are difficult to discuss and therefore to grieve because of the stigma they carry. Clients may have had relatives or friends who have committed suicide, died of drug overdoses, died from AIDS, or were murdered. People may suffer these losses in silence, overcome by shame.
  • Friendships. Many clients call the people they spend time with during active addiction “associates.” Distant are those who clients call “true friends.” Relationships with true friends have deteriorated as the substance use disorder progressed.
  • Witnessing the deaths of others. Clients who have experienced war, or who live in  violent neighborhoods have witnessed death firsthand. Others have seen people die of drug overdose or due to drug-related violence. These clients will have symptoms of PTSD, including flashbacks and nightmares. Counselors will need to work through this trauma along with the substance use disorder.

Skills substance use disorder counselors need to help their clients recover from a loss in recovery include:

  • Good listening and basic counseling skills. Most clients benefit from having a witness to their pain. This may be the most important of all grief counseling skills.
  • An awareness of the many losses clients grieve.
  • Knowledge of the fact that clients grieve in uniquely different ways.
  • An understanding of the relationship between relapse and loss and the ability to provide concrete suggestions to help clients strengthen their recovery plans when they experience loss (i.e., increase 12-step attendance, have a list of people to contact when they feel overwhelmed, utilize their personal network for support, etc.).
  • A recognition that issues around previous losses can resurface at the anniversary of the loss. Counselors need to have the ability to process upcoming anniversaries with clients. This can be instrumental in preventing relapses.
  • A recognition that tragedies are occurring in society at large can trigger grief reactions in clients. Events such as the September 11, 2001, COVID 19 losses, unemployment caused by pandemics, and news stories of catastrophic deaths can trigger grief reactions for clients seeking recovery. Substance use disorders counselors should be prepared to process these losses.

Clients with substance use disorders suffer so many losses, which, if unaddressed, can impact recovery. Every substance use disorder counselor also needs to be a grief counselor.

Learn More: Related Resources

Great Lakes ATTC: Trauma-Informed Care for African Americans with Substance Use Disorder
Mark Sanders, LCSW, CADC
Recorded webinar

Great Lakes ATTC: Implications for COVID-19 and Complex PTSD for Opioid Use Disorder
Andre Johnson, Detroit Recovery Project
Recorded webinar 

New England ATTC: The Intersection of Maternal &Infant Trauma and OUD/SUD
Dr. Jeffery Goldsmith and Katie Volk 
Presentation slides 

Central East ATTC: Trauma Awareness
Kristen Wright
News article 

Southeast ATTC: Logo Therapy: Helping Clients Turn Life Pain into Purpose in Recovery
Mark Sanders, LCSW, CADC
Recorded Webinar


Sanders, M. Slipping Through The Cracks. (2011). Health Communications, Inc. Deerfield Beach FL.