In the 1969 book On Death and Dying, Swiss psychiatrist Elisabeth Kübler-Ross outlines five stages of grief that terminally ill patients must go through before they can begin to accept their fate. Less than fifty years have passed since this book was published, yet its findings have already become accepted as practically universal fact regarding the nature of all losses. In fact, the five stages of grief are such a fundamental part of modern psychology that many of you were likely quite surprised to learn how recently they were established.
As more and more applications were discovered for the five stages of grief, it was inevitable that they would eventually be examined by addiction specialists. Over the next few weeks, we’d like to examine these stages in a multi-part series on how to process these stages while entering into a period of recovery. For now, however, we’d like to start with a brief outline of the five stages of grief, as well as some information on how they are experienced and why they are so important for addicts to understand.
Outlining the Five Stages of Grief
The five stages of grief are also known as the Kübler-Ross model, or DABDA. This stands for the five stages of grief in their commonly accepted order: denial, anger, bargaining, depression and acceptance. While Kübler-Ross examined these stages as they applied to death, one may experience the five stages of grief due to a much less significant loss. While there is some criticism of these stages, many believe that they are actually necessary in order for the grieving party to learn how to properly cope with their loss. At the end of this five-stage journey, many people will learn to grow.
Denial is the stage which is most separated from this growth. When a person is in the throes of denial, they are incapable of recognizing their situation for what it truly is. They might suspect the truth from time to time, but they will often find ways of rationalizing around it. This does not mean that they are intentionally lying to themselves or to others. It simply means that they are not yet capable of dealing with the truth. In some ways, this is the most difficult stage to deal with, because it is the only one of the five stages of grief that the sufferer cannot fully recognize themselves.
Once denial has subsided, the griever is likely to feel confused, frustrated, perhaps even scared. They will not handle this well, which is when they begin to exhibit anger. This can manifest itself as anything from mild irritability to insatiable rage. While the griever is primarily angry at the loss they are suffering or have suffered, they will often turn their anger outward. They may blame others for their loss, or become enraged with envy at those who they do not believe to have suffered as they have.
Eventually, the griever will learn to stop blaming others for their loss. Unfortunately, this does not prevent them from blaming themselves. In a misguided attempt to take responsibility for their situation, they will try to solve it. They will look for ways in which the loss can be prevented, or at least put off for a time. This is the bargaining stage. The bargains dreamt up by the griever are not usually sound. They are more generally on equal footing with the irrational rationalizations expressed during the denial phase. But in an effort to control their situation, the griever will continue to try and negotiate ways in which they can change—or even ways in which they could have changed—the situation that has put them at a loss.
After grappling with the bargaining stage for a time, the griever will begin to realize that the control they felt over their situation was illusory at best. Suffering this loss of control, they will begin to feel the weight of depression. This stage, which the griever has attempted to avoid since they first exhibited early signs of denial, is the stage most easily identifiable as true grief. It is also a particularly important stage, because it heralds the beginning stages of acceptance. The suffering experienced during the depression stage is indeed quite profound, but it is a necessary part of the grieving process.
The five stages of grief conclude with acceptance, although this term is frequently misunderstood. There are some who equate this stage with happiness or relief, but this is not quite accurate. Such as Kübler-Ross could not say that her patients were happy to accept that they were dying, the addict who accepts that they can never drink or do drugs again is seldom overjoyed. But once they have accepted their situation for what it is, the process of true healing can begin.
How We Experience the Stages
While the above outline is formatted as if the five stages of grief occur in chronological order, this is not always the case. Eagle-eyed readers might notice that WebMD lists the five stages of grief out of order, but notes on their page that “throughout a person’s lifetime, he or she may return to some of the earlier stages of grief.” In other words, not only do the five stages of grief not have to occur in a particular order, but each stage might be revisited at any time.
It all depends upon the person’s situation. Someone who is grieving over a rumor that their favorite restaurant may be going out of business will not grieve in the same way as someone who is grieving the end of their active addiction. They might deny the restaurant’s foreclosure, get angry when someone disagrees with them, brainstorm ideas to keep the restaurant open and get a little depressed over supper, but they will probably come to reach acceptance by the end of the day. For those who are grieving over more significant problems, the five-step journey toward acceptance can take days, weeks, or months.
WebMD also notes that there is “no time limit to the grieving process.” In some cases, it might take years. For some people, acceptance might not be reached on any sort of permanent basis. The addict who does not maintain a solid program of recovery might regress back into anger or denial, sometimes almost without warning. Someone who has mourned the loss of a beloved family member might succumb to depression on the anniversary of their death.
In short, acceptance does not signify the end of the grieving process. It is merely the point at which the process becomes easier to deal with. When someone finds themselves reliving one or more of the stages, then there is usually some growing that must still be done. But now that they understand what they are going through, it will not be quite as rough as it was the first time around. So while the five stages of grief might be experienced multiple times, that is not to say that each experience with one of the stages will be identical. If acceptance has been truly reached at any point, future iterations of the anger, bargaining and depression stages should be much milder than before.
Note that, in the above sentence, “mild” does not necessarily mean “easy.” The anger and depression suffered through grief can be supremely intense, even when the sufferer is aware of the process entailing the five stages of grief. The primary benefit of understanding this process is merely that the emotions of grief are not wrapped up in as much confusion and fear, because the griever is already aware of what they are going through. By lessening the fear and confusion through understanding, the griever is able to better focus on their emotions so that they may begin to move on.
Due to the above factors, one should not expect that they can make predictions their journey through the five stages of grief. In truth, there is no easy way to prepare a person for this process because everyone experiences the five stages of grief differently. Some people might even experience multiple stages at the same time, experiencing intermittent bouts of anger and depression or using bargaining as a means to prolong their denial. Some may also be grieving multiple losses, which can make the entire process much more complicated. In short, the grieving process cannot be suspended due to preparation. One must go through these five stages of grief, in whatever order they should strike, in order to cope with the loss at hand.
Applying the Stages to Addiction
Writer and graphic designer Beth Leipholtz contributed an article to the Huffington Post in November of last year which details how the five stages of grief pertain to sobriety. Even though the addict or alcoholic should be happy about learning to deal with their disease in a happy and healthy manner, they still need to grieve the loss of their former selves. But many of them have been doing this since long before they entered recovery, as a lifestyle of addiction is often fraught with losses.
During active addiction, it is easy to deny that substance abuse is a problem. Some will joke about alcoholism, as laughter is one of the easier defenses in the book. Others will simply deny that they are abusing chemicals any more than the average person. Denial can be so strong, some addicts will continue to deny their addiction long after it has had major consequences such as increasingly frequent legal problems or dropping out of school. In early recovery, those who are in deep denial will believe one of two things: that treating their addiction is a waste of time, or that recovery is a breeze and will take no effort whatsoever.
Anger is a familiar feeling to many addicts who have felt challenged any time a person has asked them whether or not they might have a problem. Being asked (or sometimes told) about their addiction is a major threat to their denial of it. When they are confronted about their destructive behavior, they will often blame those around them rather than taking responsibility for their actions. In some cases, the addict may become physically violent. Anger can also be experienced during recovery, especially when the addict is still going through the natural detoxification process and is aching for a fix. They will likely experience a bit of envy as well, feeling that it is unfair for them to undergo treatment when there are so many non-addicts who are able to drink without consequence.
By the time most addicts enter the bargaining phase, it can safely be assumed that they have begun to realize the nature of their problem. Of the five stages of grief, bargaining is one of the few that is likely to manifest itself in the same way whether the addict is in recovery or still using. They will begin to look for ways in which they can drink like a “normal” person. Chapter 3 of the AA Big Book claims the “great obsession” of every alcoholic to be the belief that “someday he will control and enjoy his drinking.” In pursuit of this obsession, one might bargain that they will only drink on weekends. They might pledge to “cut down.” They might think that they can still drink or use drugs in recovery as long as they are not using their drug of choice. But addiction just doesn’t work that way.
Depression might easily accompany many of the above steps throughout both addiction and recovery. In the case of active addiction, it will probably be brought on by the realization that one is spiraling. Someone who had been in denial and believed themselves to be a functional alcoholic will realize that they do not perform well when they are drunk. On the other hand, they don’t feel right when they are sober. They’re simply stuck. In recovery, this realization will hit the addict like a ton of bricks as they come to the conclusion that they simply don’t know how to function without their preferred substance in their system. This will pass, for the most part, but it takes a lot of time and a lot of work.
As the addict or alcoholic begins to ready themselves for Step One (assuming they are using a 12-step model for recovery), they will reach the stage of acceptance. As previously noted, this might not last forever. The addict must be on their guard, catching themselves before they slip back into denial. Otherwise, they run the risk of suffering a relapse. Bargaining, wrapped in denial as it is, can also lead the addict to use again. Anger and depression can also be major triggers. But if they are truly able to take that first step, and hold it dear to their heart, then they stand a chance at real recovery. Even if they should suffer a relapse, they might view this as simply another run through the five stages of grief. As long as they yearn to seek acceptance once more, their relapse does not have to last forever.
The rest of this multi-part series will examine each of these five stages of grief one by one, providing more details on how they affect addiction and recovery. Since addiction is a family disease, we will also be exploring how the five stages of grief factor into codependency. We hope that you will find this examination interesting, whether you are a recovering addict or have simply come into contact with addiction through a friend or family member. We all suffer the five stages of grief at one time or another. But as long as we don’t lose sight of the important things in life, we can all come out on the other side of acceptance as enlightened, strengthened, and sober individuals.