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.

Advertisements