Grief and Pain

Management for Adults

with Substance Use
Disorder
Yesenia Watt • 11.30.2023
 Substance Use
Disorder Criteria
Alcohol Use Disorder
Diagnostic Criteria Withdrawal

● Alcohol is taken in large ● Autonomic hyperactivity

amounts or over a longer ● Increased hand tremor
period of time. ● Insomnia
● Only or mostly engaging in ● Nausea or vomiting
activities necessary to ● Hallucinations/illusions
● Anxiety
obtain/use alcohol or recover
● Generalized tonic-clonic
from its effects
seizures
● Persistent desire or
unsuccessful efforts to “cut
down” or control alcohol use.
Cannabis Use Disorder
Diagnostic Criteria
● Cannabis is taken in large
amounts or over a longer
period of time.
● Only or mostly engaging in
activities necessary to
obtain/use cannabis or
recover from its effects
● Persistent desire or
unsuccessful efforts to “cut
down” or control cannabis
use.
Withdrawal
● Irritability, anger, or aggression
● Nervousness or anxiety
● Sleep difficulty
● Decreased appetite or weight
loss
● Restlessness
● Depressed mood
● At least one of the following
physical symptoms: Abdominal
pain, shakiness/tremors, fever,
chills, headache, or excessive
sweating.
Opioid Use Disorder
Diagnostic Criteria Withdrawal

● Opioids are taken in large ● Dysphoric Mood

amounts or over a longer ● Nausea or vomiting
period of time. ● Muscle aches
● Only or mostly engaging in ● Diarrhea
activities necessary to ● Fever
● Insomnia
obtain/use opioids or recover
● Lacrimation or rhinorrhea
from its effects
● Pupillary dilation or sweating
● Persistent desire or
unsuccessful efforts to “cut
down” or control opioid use.
Therapeutic Application

DBT ACT

● Interpersonal Effectiveness ● Committed Action

● Distress Tolerance ○ Behavior change goals
● Emotional Regulation
Identified Problems

● Disruption in relationships
● Impacted work or school performance
● Physical health issues
● Changes in behavior
● Money issues
What is Grief?

Grief is the natural reaction to loss. Individual

experiences of grief are influenced by the nature of
the loss. Experiences that lead to grief may include:

● Death of a loved one

● Loss of a job
● The end of a relationship
● Personal change/ growth
What is Pain Management?

● Pain management is the process of using

different techniques to lessen or mitigate
different types of pain.
Grief and Pain Management
Concepts
● Positive and Negative Self Talk
● Understanding Different Grieving Cycles
● Learning Coping Strategies
● Ending Stigmatizations
● Pain Mitigation
● Mindfulness
Positive and Negative Grieving Habits: Sunflower
Activity

Goals:

● Patient will demonstrate the

ability to reframe negative
grieving habits into positive.
● Patients will show compassion
for themselves through the
reframing process.

Intervention
Sunflower Activity Pictures
Observations

● Patients appeared to enjoy this

group
● Productive conversation about
grief and emotional pain.
● Patients were able to relate this in
a different group.
Grief Cycles: Squiggle Art Activity

Goals:

● Patients will learn a new idea of

how grief might be for them.
● Patients will express how grief
affects them and their healing
process.
Intervention
Observations

● Patients were able to describe

their personal grieving cycles.
● Patients had a productive
discussion about the process of
grief.
Learning New Coping Strategies: Dopamine Menu

Goals:

● Patients will be able to describe

three different coping
strategies.
● Patients will be able to describe
why coping skills and play are
crucial in recovery
Intervention
Extra Dopamine Menu Pictures
Observations

● Patients discussed the importance

of natural dopamine.
● Patients were intentional with
what they wrote down in each
section.
● Patients were taught the
importance of play.
Ending Stigmatizations: Taboo Game Activity

Goal:

● Patients will have a discussion

about the definition of ”taboo”
and. ”taboo subjects” (i.e. pain,
mental health, addiction, etc.)
● Patients will discuss the
importance of ending
stigmatizations surrounding
“taboo” subjects.

Intervention
Observations

● Patients described taboo subjects

and situational taboo topics.
● One patient disagreed with the
concept of ending
stigmatizations.
● Other patients supported peer
through his processing.
Pain Mitigation: Using Pain Management Bingo

Goal:

● Patients will create positive

pain management strategies for
themselves.
● Patients will identify two new
strategies for pain mitigation.
Intervention
Observations

● Patients were able to explain

their personal pain management
strategies.
● Patients discussed physical pain
and how it can impact mental
health.
● Patients discussed the difference
between emotional pain and
physical pain.
Mindfulness: Stretching Group
Goals:

● Patients will learn a new

technique of pain mitigation.
● Patients will demonstrate focus
on the present moment.
Intervention
Observations

● Patients highly enjoyed this

group.
● Patients talked about the
importance of stretching.
● Patients taught stretches to peers.
Honorable Group Mention
Future Application

● Additional groups
● Groups can be run with other populations and diagnoses
● Research opportunities
○ Obtaining information through post-group surveys
Questions?
References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed.). Washington, DC, 156-160.

Intervention Protocol:

https://docs.google.com/document/d/
1T4vlQPzOw4OH770Yb7cB0G60aY5U4OjUiJPD9EOE8m4/edit?usp=sharing