Change is an inevitable part of life and there is always an element of loss associated with that change. When loss becomes too difficult for some people to bear, alcohol and drug use becomes an immediate remedy in ‘taking out the edge’ from fully experiencing the significant loss. And consequently, grief becomes suspended and unresolved, and substance use generates a host of problems for the substance user, their family, friends and society. Such losses, and subsequent grief, may be either mortal or non-mortal in origin.
The aim of this study is to obtain an overview and analysis of effective loss, grief and substance abuse interventions to inform future planning and work within alcohol and drug services in New Zealand. Three questions guided this review: (1) is there a relationship between, loss, grief and substance abuse? (2) Does addressing loss and grief in alcohol and drug counselling help reduce substance use and associated harms? and (3) What interventions are most effective in assisting alcohol and drug clinicians working with bereaved clients (Māori and non-Māori)?
A structured literature review was conducted, searching CINAHL Plus, PsycINFO, Scopus, Medline, DRUG, and Social Work Abstracts Plus databases, commencing from start date of each database, and month the search were conducted in, October 2014. The search terms were grouped into three main search categories: ‘Grief’, ‘Substance Abuse’ and ‘Interventions’. Eligible studies included: (1) interventions for loss, grief and addictions (2) measurement instruments used for examining grief and or addictions, and (3) full text articles published in English or Māori.
Despite searching the 6 databases and finding 11,963,418 references, only 7 articles were extracted that fit the inclusion criteria. In analysing these articles, 5 themes emerged and were explored: (1) the nature of loss and its relationship to substance abuse (2) socio-demographic factors of the bereaved (3) the use of assessment and screening instruments (4) grief interventions (individual and group therapy), and (5) the nature of specific populations (gender differences, mental health and substance abuse disorders, and indigenous populations). Overall, the studies showed grief interventions helped to decrease symptoms of grief, substance abuse and mental health problems, and increased self-esteem, spirituality, confidence, and personal growth among the bereaved. Limitations identified in the studies included limited demographic data, a lack of control groups, small sample sizes, and studies based primarily upon Caucasian and African-American individuals living in North America with one exception in Hungary.
Despite abundant research on loss and grief, and on substance abuse, there is a paucity of studies being conducted on their co-existent relationship. It is clear from the findings that grief interventions are useful in helping the bereaved identify their losses, and help them to find purpose and meaning to their sorrow. Appropriate interventions led to an increased self-esteem, and reduced symptoms of grief and substance abuse. The findings guided fifteen recommendations for future research, practice and policy, including: (1) To explore the impact of strength based instruments and interventions of resiliency enhancement on grief and substance abuse relapse, (2) To explore and develop more culturally appropriate screen and assessment instruments, models, tools, and interventions related to loss, grief and addictions in Maori, Pacific Nations and other populations in Aotearoa New Zealand, and (3) that alcohol and drug clinicians, health professionals and social work practitioners be provided with specialized training in loss and grief.