Loss, and the accompanying grief, hitting young patients hard

The experience of loss and grief will touch everyone at some point in life. But for many young people caught in the throes of an opioid epidemic, these challenges are arriving much too fast and far too often. Most are ill-equipped to process the feelings that arise from seeing friends and loved ones die from addiction.

“They don't necessarily think they themselves are going to die, so they struggle to grieve when the concept doesn't seem real,” James Ryan, director of Ashley Addiction Treatment's Young Adult Extended Care Program, tells Addiction Professional. “They don't necessarily have the language to talk about it, the vocabulary to articulate it.”

Ryan says that without exception, every young adult man who has gone through Havre de Grace, Md.-based Ashley's 90-day, two-phase treatment program has come in having experienced a loss. This is one of many byproducts of a far-reaching opioid epidemic.

“We have a patient now coming in who has had two family members and a friend die in the past six months,” says Ryan.

For many, grief also is linked with trauma. It is not uncommon these days for young adults entering treatment to have witnessed a drug-using friend die in their presence. “I've heard pretty tragic things,” says Patrick Trentalange, a counselor in the young adult program.

'Superman' no more

For many young people in treatment for a substance use problem, the “Superman” syndrome that manifests in risk-taking and the idea that “it will never happen to me” is suddenly colliding with the reality of death around them. Part of the assessment process in Ashley's young adult program addresses issues around grief and loss, and clinicians often find that the young people can cite losses in their lives but are less able to understand how these experiences have affected them.

Ryan recalls the situation of a young man whose guardedness in treatment eventually was traced to the grief he was experiencing over a friend's recent suicide. After some work, “He was able to say he lost someone he cared deeply about,” says Ryan. “But it doesn't need to define him.”

One of Trentalange's patients was carrying feelings that he had been responsible for the overdose death of a friend—that he somehow had let the person down. Eventually he would come to the realization that he had done the best he could.

“It's tough to get them to think, 'This too can apply to me,'” Trentalange adds. “Death doesn't seem to be a real option.”

In cases where a traumatic form of grief is apparent, the program will refer a patient to Ashley's grief group, overseen by staff psychologist Aaron Ramirez, PsyD. Here the younger patients will interact with Ashley's general treatment population. The goal here becomes helping the patient move from unresolved resentment, guilt and other emotions to a place where sadness may persist but functioning is not impaired. In all cases, sufficient time is necessary to reach this point.

“I actually tell them they're blessed,” Ramirez says, “because we have a solution that works.”

Besides its goals of seeing patients engage in treatment and pursue continuing care, the Ashley program seeks to have its young patients connect more meaningfully with others. “The pain we experience in relation to others is actually a gift,” Ryan says.