Grief and addiction can become difficult to separate when substance use starts or escalates after a loss. Drinking may become daily after a partner dies, or prescription medication use may increase after bereavement. By the time someone seeks treatment, the original loss may have been overlooked.
Integrated care makes room for both the substance use and the grief that may be driving it.
Grief is not a disorder, but it can develop into one
Grief is a normal human response to loss. It is painful. It is not, in itself, a clinical condition. Most people, given time and support, move through grief without specialist intervention.
For some, however, grief takes a more clinically significant shape. Recent diagnostic developments recognise Prolonged Grief Disorder as a distinct condition, characterised by:
- Intense yearning or longing for the deceased.
- Preoccupation with thoughts or memories of the deceased.
- Identity disruption (a sense that part of oneself has died).
- Marked sense of disbelief about the death.
- Avoidance of reminders that the person is dead.
- Intense emotional pain related to the loss.
- Difficulty engaging in social or other activities.
- Emotional numbness.
- A sense of life being meaningless.
When these persist beyond what is expected (typically more than a year for adults), and cause significant impairment, this is the territory of prolonged grief.
Prolonged grief and substance use are commonly entwined. Each maintains the other.
Why grief triggers substance use
The acute pain is unbearable
In the early weeks and months of severe loss, the pain can be physical, constant, and overwhelming. The mind looks for relief. Substances offer immediate, reliable, if temporary, numbing.
Sleep disruption
Grief disrupts sleep profoundly. Some people use alcohol, cannabis, or sedatives to sleep. The pattern can become an established dependence within months.
Avoidance of reminders
Substances allow the person to be present-but-not-present, attending family gatherings or going through daily routines without fully experiencing the absence of the lost person. The numbing function is one of the most common drivers.
Disrupted routine
Loss often disrupts the structures that previously held a life together: shared meals, household rhythms, work patterns. Substance use can fill the new unstructured time.
Loss of identity
Loss of a spouse, child, parent, or close relationship is often loss of part of one’s identity. Substances can fill, badly, the space the lost relationship occupied.
Suppressed grief in the family
Where the family does not process grief openly, the grief moves into other channels. Substance use is one of these.
Anniversary reactions
Each anniversary, holiday, and meaningful date renews the grief. People may drink or use to manage these. The pattern can persist for years.
Existential disorientation
Significant loss often shakes the person’s sense of meaning. Substances can numb the existential discomfort, without addressing it.
When grief and substance use reinforce each other
The interaction tends to be self-reinforcing.
- Substance use suppresses the grief work that needs to be done.
- Unprocessed grief becomes a chronic background state of distress.
- The distress drives further substance use.
- Substance use compounds the depression and isolation that grief produces.
- Over time, the original grief becomes hard to disentangle from the addiction.
By the time the person reaches treatment, they may not see the grief as the original driver. They have been using for years. The addiction has its own momentum. But underneath, the unprocessed loss is still there, and recovery has to include it.
Why this picture is often missed
Several reasons grief is under-recognised in addiction treatment.
Time
If the loss was years ago, it can feel inappropriate to revisit it. The cultural expectation is that grief has a timeline. In practice, grief without proper processing can sit for decades.
Stoicism
In many cultural contexts, including parts of South African culture, expressing grief is discouraged. People are praised for “being strong.” The grief goes underground.
The addiction dominates the clinical picture
The visible problem is the substance use. The clinician treats the visible problem and may not ask about underlying loss.
Loss is not always death
Grief can follow divorce, job loss, miscarriage, loss of health, loss of homeland (relevant for many South Africans of various backgrounds), loss of identity, loss of relationship. These losses are sometimes not recognised as grief, even though they activate the same processes.
Complicated bereavement
Where the loss involved difficult circumstances, suicide, sudden death, complicated relationship, traumatic loss, the grief is more likely to remain unprocessed and more likely to drive maladaptive coping.
What effective treatment looks like
Comprehensive assessment
The assessment process at Anker Huis includes specific questions about loss. We explore what losses you have experienced, how they were handled at the time, your relationship to them now, and whether substance use began or changed around those losses.
This exploration sometimes surfaces the original driver in a way the person had not consciously connected before.
Stabilisation first
Acute grief and acute withdrawal are both destabilising. The early phase of treatment is about stabilisation: physical recovery, sleep restoration, basic emotional regulation. The grief work proper comes once the system is steadier.
Grief-informed therapy
Once stability supports it, structured grief work becomes part of the therapy. This may include:
- Constructing the story of the loss in detail, often for the first time without substance interference.
- Engaging the avoided reminders gradually.
- Working with the relationship to the deceased, including continuing bonds (a sense of ongoing relationship with the person who has died, which is now understood as a healthy part of grief rather than a problem).
- Working with the role of the lost relationship in the person’s identity.
- Addressing unfinished business: things unsaid, things regretted, things left unresolved.
Trauma-focused therapy where indicated
Where the loss was traumatic (sudden death, witnessed death, suicide of a loved one), trauma-focused therapy (EMDR or trauma-focused CBT) is often appropriate.
Family inclusion
Where the loss was shared, family work can address the way the loss has shaped the family system. Family members are often grieving in their own ways, sometimes also through substance use, sometimes through other patterns.
Spirituality and meaning
Many people find that loss reshapes their relationship to meaning, faith, and the larger questions. Where this is part of the person’s recovery, the therapeutic work includes space for it. This is led by the person’s experience and is not imposed.
A note on suicide bereavement
The bereavement that follows the suicide of a loved one is one of the most difficult forms of loss. It carries particular features: shock, guilt, anger, complex relational grief, stigma, sometimes the difficulty of public conversation. Substance use in suicide bereavement is common.
At Anker Huis we approach this specific picture with particular care. The work includes the grief, the trauma where present, and the broader life impact, alongside the substance use treatment.
If you are bereaved by suicide and substance use has become part of your way of managing, please know that this combination is well-recognised clinically and that integrated treatment exists.
A note for families
If a family member’s substance use began or escalated after a loss:
- Do not assume the loss is in the past simply because time has passed.
- Be careful about adding “you should be over it by now” to the pressure they are already carrying.
- Make space for memory and conversation about the lost person. Avoiding the topic does not protect the bereaved person; it isolates them further.
- Recognise that you may also be grieving and may need your own support.
- Consider clinical involvement before the substance use becomes severe. Earlier intervention is more workable than later.
FAQ: grief and addiction
Is it normal to use alcohol to get through grief? Many people drink more during acute grief. This is common and not necessarily pathological. The concern is when the pattern persists, escalates, or replaces the actual work of grief.
How long does grief usually last? There is no single answer. Acute grief typically eases significantly within months, but waves of grief can recur for years. Prolonged grief disorder is diagnosed when significant impairment persists beyond about a year.
Can grief therapy help even if the loss was decades ago? Yes. Unprocessed grief from many years ago can be addressed in therapy and significantly improved.
Does Anker Huis include grief work in addiction treatment? Yes. Where loss is part of the underlying picture, grief-informed therapy is integrated into the treatment plan.
What if I lost someone to addiction myself, and now I am using? This pattern is real and not uncommon. Specialist support exists for bereavement by addiction-related death, and this is a relevant feature of treatment for you.
Can faith or spiritual support replace clinical treatment? Faith and spiritual practice can be deeply supportive in grief and recovery. They are most helpful alongside, rather than instead of, clinical treatment when the substance use has become significant.
If loss has shaped your relationship with substances, Anker Huis provides care that addresses both. Call +27 72 088 0446 or email info@ankerhuis.co.za for a confidential conversation.
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