Abstract
The following two case reports discuss the effect of grief on their drug-use behaviour. Both case descriptions of substance use disorders are comorbid with depression and/or an anxiety-related disorder. Case 1 and 2 have a history of childhood sexual and physical abuse and report multiple drug relapses as a consequence of unresolved grief associated with the abuse. The maladaptive grief process of case 1 and 2 had presented itself in the subjective belief of having after death communications with the deceased. The application of cognitive behavioural techniques driven by psychodynamic insights, revealed a relationship between the grief experienced, childhood abuse and the use of prescription medication and illicit drug use. The case descriptions of grief are discussed in the context of substance misuse, mental health and the triggers associated with relapse in an attempt to further our understanding of substance abuse and therapy.
Highlights
The foundations to our understanding of the intra psychic processes of grief have been originally laid by Freud in his discussion of ‘mourning and melancholia’, followed by subsequent psychodynamic approaches on the mechanisms of defence, object relations and unconscious conflicts [1,2]
The application of mindfulness based cognitive behavioural techniques driven by psychodynamic insights revealed a relationship between the grief, childhood abuse and the use of prescription medication and illicit drug use
Whilst childhood anxiety disorder was significantly associated with complicated grief, interestingly no such relationship existed between childhood separation anxiety, Post Traumatic Stress Disorder (PTSD), anxiety and depression
Summary
The foundations to our understanding of the intra psychic processes of grief have been originally laid by Freud in his discussion of ‘mourning and melancholia’, followed by subsequent psychodynamic approaches on the mechanisms of defence, object relations and unconscious conflicts [1,2]. The application of mindfulness based cognitive behavioural techniques driven by psychodynamic insights revealed a relationship between the grief, childhood abuse and the use of prescription medication and illicit drug use Both cases discussed how both a lack of closure and guilt associated with the death of a significant other were triggers to a drugs relapse, often upon waking. Case 1 and 2’s childhood abuse had caused significant distress centring on a lack of closure and a need for acceptance, and resulted in self-medicating with poly-substance use. The therapeutic arena has provided both cases with a means of expressing their thoughts and challenging their self-defeating beliefs Those interventions have encouraged them to recognize how their emotional distress was not allowed conscious experiencing due to their punitive rules for living and insecure object relations, resorting to substances to numb difficult emotions and perpetuate their pathology. Exploring interpersonal cognitions and core beliefs of the cases has provided a means for developing the therapeutic tools necessary to encourage and support them during times where a potential trigger, owing to grief, has precipitated a relapse
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