Kubler-Ross and the five stages of grieving in substance abuse

Kubler-Ross, who really should have a little umlaut on her U but I do not have the html skills to facilitate that, wrote about the five stages of grief after working extensively with terminally ill patients.  That much I knew.  What I didn’t know, until today, was that she expanded her model to deal with a number of other forms of grief, including break-ups and addiction.  

Here’s the Wikipedia summary of how the model applies to addiction recovery:

Denial

People feel that they do not have a problem concerning alcohol or substances. Even if they do feel as if they might have a small problem they believe that they have complete control over the situation and can stop drinking or doing drugs whenever they want. Example: “I don’t have to drink all of the time. I can stop whenever I want.”

Anger

The anger stage of abusers relates to how they get upset because they have an addiction or are angry that they can no longer use drugs. Some of these examples include “I don’t want to have this addiction anymore.” “This isn’t fair, I’m too young to have this problem.”

Bargaining

This is the stage that drug and alcohol abusers go through when they are trying to convince themselves or someone else that they are going to stop abusing in order to get something out of it or get themselves out of trouble. Example: “God, I promise I’ll never use again if you just get me out of trouble.”

Depression

Sadness and hopelessness are important parts of the depression stage when dealing with a drug abuser. Most abusers experience this when they are going through the withdrawal stage quitting their addiction. It is important to communicate these feelings as a process of the healing.

Acceptance

With substance abusers, admitting the existence of a problem is different from accepting the problem. When a substance abuser admits that he/she has a problem, this is more likely to occur in the bargaining stage. Accepting that he/she has a problem is when you realise that you have a problem and start the process to resolve the issue

So I read this excellent post about grieving in early sobriety and thought but I’ve DONE the grief bit, I’m at the acceptance bit, I keep talking about the acceptance and I get that there is a problem and it’s goodbye forever, surely that means I’m good to go?

And then I read the above.  And then I read it again.  Specifically, this bit:

Bargaining

This is the stage that drug and alcohol abusers go through when they are trying to convince themselves or someone else that they are going to stop abusing in order to get something out of it or get themselves out of trouble.

Before I read the explanation, I was dismissing the bargaining stage as the failed-moderation stage.  You know.  I’ll just drink two glasses of wine a night, just let me keep drinking.  I’ll only drink on weekends, just let me keep drinking.   And some journals also parse it the same way.  But I don’t think it is.  Bargaining is when you give up, or promise yourself you will give up, in order to get something out of it.  Forgiveness, maybe.  A second shot at a tottering relationship.  A warning instead of a gaol term.

When applied to grief, this looks like ‘take me instead of him’ or ‘I’ll never shout at her again, I’ll let her stay up late and give her double the pocket money if only’.  Which is more like the moderation fallacy; I will change my behaviour in order to avoid suffering the loss.  But here, we’re not talking about that.  We’re talking about giving up the substance in order for a stated reward.

As I understand it, and I’m no psychologist, you can’t get past here and into acceptance unless you tackle the loss on its own terms.  As a thing that exists in and of itself, not as something you’ve voluntarily incurred only on the basis that you get something in return.  The loss is the loss; it exists because it has to, because there are no viable alternatives.

I think that what I’ve been doing, as evidenced by my many complaints about life failing to turn me into a mythical rich, thin, successful Somebody Else, is bargaining.  I thought the other day; would I have given up drinking if I hadn’t been sure that it would make me lose weight?  No, I probably wouldn’t have.  The thing that tipped me over the edge and into ‘hell, let’s do this thing’ was Lucy Rocca’s book The Sober Revolution, which promises, pretty much, that if you give up booze you will end up thinner, richer, more motivated, with spare time on your hands and the energy to use it.  I read it, and I believed it, and I thought yes, that seems like a good deal.  No alcohol, in exchange for more time, more energy, more success, a more defined waistline and more money?  Yes, that’s a good bargain.  Here’s my alcohol, give me those other things.

And then I held on and waited.  And waited.  And 60-something days down the track, it’s pretty obvious that it doesn’t work that way at all.  Bargaining doesn’t work, and I feel ripped off.  Duped.  But at the same time, I can’t really go back now.  Lilly’s right, you’re all right: it won’t be fun any more.  The loss is what it is, and it exists on its own terms.  I can’t bargain.  I have nothing with which to bargain.

No wonder I’m depressed.  It’s the next stage.

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17 thoughts on “Kubler-Ross and the five stages of grieving in substance abuse

  1. another cracker of a post, After. thank you for this great perspective. I love your line: ‘The loss is the loss; it exists because it has to, because there are no viable alternatives.’
    in my sciency background the word viable has a particular meaning: not only feasible, or realistic, but more specifically meaning ‘able to live and grow’. which is what being sober means to me, so thank you for that thought process too.
    I would say that having ‘let go’ of the bargaining side then the rewards will come of their own accord. in particular going back through old emails to Belle recently I noticed that at just under three months I was still complaining of having no energy after 5pm, when previously I would be whizzing around with a glass in my hand until 9pm when I collapsed on the sofa… well at 6 months I am now doing the latter again without having even noticed that the energy is back. except this time it is me, rather than the sauv blanc, doing the whizzing.
    if you build it, they will come :) xx
    PS but Ray Liotta is mine. all mine ;)

  2. So glad to read this post. Hang in there girlie. It will get better, I PROMISE. Depression is no fun, I know, but at least you know the reason now, right? That always made me feel better to KNOW why i felt so crappy. I’m sending you hugs and also wanted to second what Lilly said. If you wanna email me (msbecca@sunnysanguinity.com), you’re totally welcome and if you have Whatsapp we can text too if you’re struggling. Or if you just wanna chat :) HUGS to you!

  3. Really interesting, thought provoking post – thank you :) And I’m with you on the time thing – where is all this time that I am supposed to magically have on my hands?? I guess it’s something to do with small children. They just eat it, don’t they? Hang in there with all of these stages… I guess they don’t all come and go in order as we tick them off the list, but reappear annoyingly at random, esp when you are tired and / or stressed. Also, no idea if this is true or not, but have heard that symptoms of PAWS can get worse at 30, 60, 90 days etc. Whether or not this is the case, I am sure that time will help, and lots of self care :) Did you ever get your luxurious pyjamas? Hugs. xxx

    • They are on order from England, thank you for asking! I’m not very good at this treat thing though; bought myself a lovely scented candle a month ago, and haven’t lit it yet.

  4. So I tried to comment last night and did a ten minute section and then lost it! arrggghhh. I am just at day 60 myself. I can totally relate to the down part of the recovery. I too am having those days at work where I have pits in my stomach and for the first time am not self medicating myself so I guess it is forcing me to deal with the feeling I numbed for so many years. I miss the drinking. I was on a business trip this week and my feelings were a combination of “i want to take my laptop down to the bar and have a glass of wine and work” to “I can’t believe I used to drink that much and how embarrassed I am for some of the situations I now recall”. It is such a double edged sword. I would love to go back and enjoy drinking, but I just can’t. There was so much sneaking around, spending money, hiding bottles in the car I purchased when I was out so my husband wouldn’t see. I don’t miss that part of it. I do miss just being able to numb myself to the shitty people in this world. And yes, there are shitty people, for sure.
    Hang in there. As a mom of two boys, married and working, I can relate to the fact that you just want life to slow down and some peace and quiet. Sometimes life is so busy I just want to step off! One thing I did start doing, something I never ever thought I would like, is yoga. I started taking it a few weeks ago and the first time my mind would not quiet down but every time it is a little better. I need help with quieting myself down and not stressing out about other people, their perceptions and my reaction to them.

    Drinking isn’t your answer, tempting but will not solve your problems. I think this is one of those phases of grief that letting it wash over you may be the best way to handle it. Hang in there, sending you a big hug. RunnerMom (and I dont run a lot either)

    • Thank you for going to the effort of commenting twice! Yes, drinking isn’t the answer. It wouldn’t even be fun, it would be self-flagellation. Good to have another person at the same stage as me – it feels like forever but we’re such fledglings really I guess.

      • Me too, for what it’s worth. That’s three of us not running, eating crap and wishing we could find something to make it stop. I don’t really have any ideas except food and alcohol. God, that’s really depressing. I’m bargaining, I’m doing this so I don’t die. That simple. I have everything and yet I can’t believe I want any of it half the time and I’m so _afraid_.

      • You sound very down, KT, I’m sorry. I think – and I don’t know this – that no matter what sort of rock bottom one hits, no matter how obvious it is that there’s no other choice, it still feels like bargaining until it doesn’t. This might be what the AA people call being a dry drunk – it’s when we embrace sobriety for its own sake, not to avoid the bad things that alcohol brings but for the good things that sober life does – that we start to be free.

        Hang in there. Let’s not drink today, and then see how it goes tomorrow.

  5. I’m so relieved and excited that other people have talked about recovery as grieving! I spent so many miserable hours fighting with people about “how I could act like I missed it” and “why I’m not over it” and “if I loved them or cared about anyone but myself I’d be happy and have no other feelings about being clean/sober”. I kept trying to explain that I had taken a loss and felt alone and confused, and they kept yelling about how if I were sincere I wouldn’t feel the way I did. And all the while, there were people who knew what I meant, who were clean and sober and talking about it. Excellent post.

  6. Reblogged this on Sober Something and commented:
    Excellent blog post about the stages of quitting…thought-provoking & I remember going through this is my early recovery(s). Didn’t manage to move into long-term recovery only I finally managed to get to Acceptance.

  7. The timing of this is perfect! I just wrote a whiny post about loss and grief and anger at just 21 days from the starting gate. Now I know I’m probably going to hang with these feelings for a while. It helps to have company!

  8. Pingback: The Five Stages of Grief in the Recovery Process from Binge Eating | Blogging Astrid

  9. Thanks for this insightful post. I don’t have an alcohol or drug problem, but I do have an eating disorder (mostly binge eating). You made me think about these stages of grief in the recovery from my overeating. I’m only at the bargaining stage I guess, since I was in denial for many years.

  10. Well written and thought out article. I believe the most important step is the last “Acceptance”. Until a person comes to the conclusion they need help then nothing will affect their life except the addiction.

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