grief and managing an overdose death...2017/07/27 · 5 educational objectives •at the conclusion...
TRANSCRIPT
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Grief and Managing an
Overdose Death
Diane Snyder Cowan, MA, MT-BC, CHPCA
Hospice of the Western Reserve, Inc.
July 27, 2017
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Diane Snyder Cowan,
Disclosures
• I have no disclosures to report.
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Planning Committee,
Disclosures AAAP aims to provide educational information that is balanced, independent, objective and free
of bias and based on evidence. In order to resolve any identified Conflicts of Interest, disclosure
information from all planners, faculty and anyone in the position to control content is provided
during the planning process to ensure resolution of any identified conflicts. This disclosure
information is listed below:
The following developers and planning committee members have reported that they have no
commercial relationships relevant to the content of this webinar to disclose: AAAP CME/CPD
Committee Members Dean Krahn, MD, Tim Fong, MD, Tom Kosten, MD, Joji Suzuki, MD;
and AAAP Staff Kathryn Cates-Wessel, Miriam Giles, Carol Johnson and Justina Pereira.
All faculty have been advised that any recommendations involving clinical medicine must be
based on evidence that is accepted within the profession of medicine as adequate justification for
their indications and contraindications in the care of patients. All scientific research referred to,
reported, or used in the presentation must conform to the generally accepted standards of
experimental design, data collection, and analysis. The content of this CME activity has been
reviewed and the committee determined the presentation is balanced, independent, and free of
any commercial bias. Speakers must inform the learners if their presentation will include
discussion of unlabeled/investigational use of commercial products.
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Target Audience
• The overarching goal of PCSS-O is to offer evidence-
based trainings on the safe and effective prescribing of
opioid medications in the treatment of pain and/or opioid
addiction.
• Our focus is to reach providers and/or providers-in-
training from diverse healthcare professions including
physicians, nurses, dentists, physician assistants,
pharmacists, and program administrators.
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Educational Objectives
• At the conclusion of this activity participants should
be able to:
Define grief, loss and related terms
Discuss common grief reactions resulting from an
overdose death
List three therapeutic approaches for working with
clients grieving a loved one lost to an overdose
death
Discuss self-care strategies to manage cumulative
grief from death of clients
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“Grieving is as natural as crying when
you are hurt, sleeping when you are tired,
eating when you are hungry, or sneezing
when your nose itches. It is nature’s way
of healing a broken heart.”
- Doug Manning
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Grief Basics
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Aspects of Grief
Physical
Cognitive Emotional
Spiritual Behavioral
Social
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Definitions and Terms
• Grief and mourning
• Anticipatory grief
• Disenfranchised grief
• Cumulative loss
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Factors Complicating Death
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Sudden Death
• No opportunity for anticipation
• Unexpected and overwhelming
• Threatens general perceptions of safety
and security
• Emphasis on “WHY”
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Issues Inherent in
Sudden Death
• Capacity to cope is diminished
• Assumptions about world are violently
shattered
• The loss does not make sense
• No opportunity to say goodbye
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• Grief symptoms persist
• Obsessively reconstruct events
• Experience profound loss of security
• Secondary losses
• Posttraumatic stress responses
Living With Grief After Sudden Loss Edited by Kenneth J. Doka PhD
Issues Inherent in
Sudden Death
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Sudden Death
Grief Reactions
• Denial and disbelief
• Disorientation
• Shock
• Confusion and panic
• Struggle to find reason
• Search for answers
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Grief Reactions with a
Substance Use Disorder Death
• Despair and sadness
• Anger
• Guilt
• Shame
• Blame
• Relief
• Frustration
• Fear and anxiety
• Stigma
• Isolation and loneliness
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Theories and Approaches
• Four Tasks of Grief (Worden)
• Meaning Making (Niemeyer)
• Dual Process Model (Stroebe and Schut)
• Therapeutic Bereavement Rituals (Rando)
• Trauma Processing Techniques
EFT
EMDR
Breathing techniques
Guided imagery
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Worden’s Tasks of Grief
Task l - to accept the reality of the loss
(not believing)
Task ll - to process the pain of grief
(not feeling)
Task lll - to adjust to a world without the deceased
(we’ll talk more on this one)
Task lV - to find an enduring connection with the deceased while embarking on a new life
(not moving forward)
(Worden, 2009)
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Worden’s Task lll
• To adjust to a world without the deceased
External adjustments: living daily without the
person – or not adjusting
Internal adjustments: who am I now? – or not
growing
Spiritual adjustments: reframe assumptive world
– or not understanding
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Dual Process Model
• Deals with 2 types of stressors
• Loss orientation
• Focuses on the deceased, death events
and losses
• Restoration orientation
• Deals with secondary stressors such as
running a household and finances
(Stroebe and Schut 2008)
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Loss-
oriented
Intrusion of grief
Breaking bonds
with the deceased
Denial/avoidance
of restoration
changes
Everyday life
experience
Restoration-
oriented
Controlled distraction
Doing new things
Attending to day-to-day
needs
Denial/avoidance
of grief
New roles/identities/
relationships
oscillation
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“Adaptation to loss involves restoration of
coherence to the narratives of our lives.”
“We construct and reconstruct our identity as
survivors in connection with others.”
“Grieving is the act of affirming or
reconstructing a personal world of meaning that
has
been challenged by loss.”
Meaning Making
- Neimeyer
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Meaning Making and
Meaning Reconstruction
• Ways to make sense of the death
• Narrative forms: reminiscing, journaling
• Artwork
• Cultural practices, spiritual traditions or
memorials
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Meaning Making Models
Bereavement Rituals
• Express thoughts and emotions symbolically
• Affirm the death
• Recall the loved one
• Express the mourner’s thoughts and feelings
• Assist in saying good-bye
• Symbolize transition back into life
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Continuing Bonds
A dynamic bond that shifts and changes over time as
the bereaved adapts to the loss through “negotiating
and renegotiating the meaning of the loss.”
Corr, Nabe & Corr (2009)
This kind of connection, “provided solace, comfort and
support and eased the transition from
the past to the future.”
Klass, Silverman & Nickman (1996)
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What Can Help Grieving Families
• Accepting the reality of the circumstances of the
death
• Finding healthy ways to acknowledge and
accept feelings
• Not defining the deceased loved one by his or
her addiction
• Educating themselves about addiction
• Finding the right support systems
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When the Bereaved are
Using or in Treatment
“Addiction is a family disease.”
“One person may use, but the
whole family suffers.”
Shelly Lewis
IdentifyProject.org
12 StepPlant.com
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Family Issues
• Overprotection
• Enmeshment
• Struggle resolving conflicts
• Extreme rigidness
• Isolation
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Using to Cope
Emotional Trigger
Use of Substance
“Relief” of emotion
Pain returns
Passage of time
Used with permission from Anna Moreno
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Options for Support
• When substance use disorder is the
primary condition
• When in treatment/recovery
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When Healers Grieve
“We cannot heal someone else until we know how to heal ourselves… We start by acknowledging our own woundedness. We enter that woundedness and work through it. By entering that woundedness and working through it, we learn how to heal ourselves and we learn how to assist in the healing of others.”
- Being a Wounded Healer: Douglas Smith
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Four Essentials
• Rest
• Physical activity
• Healthy eating
• Social connection
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Self Compassion
• Shift from self judgment to compassion
• Provide active self comfort
• Acknowledge mutual suffering
• Use affirmation
Self Compassion: Kristin Neff
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Taking Care
Notice tension
Ground yourself
Relaxation techniques
Smile
Breathing exercises
Meditation
Hold position of power
Massage
Yoga
Integrative therapies
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References
• Corr, C.A., Nabe, C.L. & Corr, D.M. (2009, 6th edition) Death and
Dying, life and living , Belmont, CA: Wadsworth Cengage
Learning.
• Doka, K. (ed) (1996) Hospice Foundation of America. Companion
Books for Annual Teleconference: Living With Grief after Sudden
Loss, Bristol, PA, Taylor & Francis.
• Klass, D., Silver, P.R., Nickman, S. (2014, first published 1996),
Continuing bonds: new understandings of grief, Hoboken: Taylor &
Francis.
• Manning, Doug. (2003, 29th ed) Don’t Take Away my Grief, In-
sight Books, Inc., Oklahoma City
• Neff, K. (2013) Self compassion, London: Hodder& Stoughton.
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References
• Neimeyer, R. (ed.). (2012) Techniques of Grief Therapy: Creative Practices for Counseling the Bereaved. New York, NY: Taylor& Francis.
• Neimeyer, R (2001) Meaning Reconstruction and the Experience of Loss. Washington DC: American Psychological Association
• Rando, T. (ed.). (2000). Clinical Dimensions of Anticipatory Mourning: Theory and Practice in Working with the Dying, Their Loved ones, and their Caregivers. Champaign, Ill: Research Press.
• Worden, J. (2009). Grief Counseling and Grief Therapy: A Handbook for the Mental Healthy Practitioner, (4th ed). New York: Springer Publishing.
• Smith, D. (1999). Being a Wounded Healer, Psycho-Spiritual Publications (1999).
• Stroebe, M.S., Hansson R.O., Schut, H. & Stroebe,W. (eds). (2008). Handbook of Bereavement Research and Practice. Washington DC, American Psychological Association.
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Questions?
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PCSS-O is a collaborative effort led by American Academy of Addiction Psychiatry (AAAP) in partnership
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