With Grief and Grace: Mourning and Resilience in the Rooms of Addiction Recovery

ABSTRACT

Therapeutic responses to substance use disorder (SUD) have been an individual and community health challenge for many years. Mutual support fellowships continue to make important contributions. The peer-based, 12 Step meeting model has existed for nearly a century, and these meetings in general, and Cocaine Anonymous (CA) meetings in particular, are therapeutic. How specific topics are engaged in meetings is not well understood, especially topics related to emotional regulation. Research suggests that addiction recovery is quite similar to, and strongly linked with, a prolonged or pathological grief. How grief and healing matter in these meetings is an important area for research. This paper explores these interlinked processes in CA meetings to understand how they contribute to resilience. Shares on grief-related topics from more than 100 CA meetings and over seven years of data collection are analyzed. Addressing grief in these meetings contributes to improved health outcomes. Grief-related topics emerged into five (5) themes. These grief discussions contributed to the presence of four (4) dimensions of a social ecology of resilience in recovery.

Keywords:

• Grief
• resilience
• substance
• use disorder
• cocaine anonymous
• social ecology

Introduction

There are many uncertainties regarding substance use disorder (SUD) and healing responses to it in these early decades of the twenty-first century. Despite slight declines in the last year, overdose complications and deaths have both increased dramatically over the last decade (Baumgartner & Radley, 2023) and the COVID pandemic has made this and related trends of compromised mental health more unsteady (Dubey et al., 2020; Henry et al., 2020; Khan et al., 2022). Yet the challenge of effective therapeutic responses to SUD was an individual and community health challenge long before the COVID pandemic began. Now, medication-assisted treatment (MAT) is increasingly valued. Some research suggests that increased access to MAT and harm reduction resources in the coming years will help reduce healthcare system costs, reduce the likelihood of more than five million overdoses, and save nearly one million lives (Chen, 2018). These benefits are most likely to occur when they are combined with other therapeutic modalities of SUD care, including the ongoing contributions of mutual support fellowships (Chen, 2018; Laudet, 2008).

Community-based health initiatives are among therapeutic and preventive modalities of SUD care. Their help to reduce SUD and improve community health has been sustained, as has their contribution to reducing marked race and ethnic disparities in SUD treatment access (Sahker et al., 2020). 12-Step organizations have a long history of being hosted in community-based health initiatives (Boeri, 2018; Briggs, 2012; Price-Spratlen, 2022). Such collaborations are often underfunded and precarious. Still, many of these health initiatives manage to keep their doors open, and continue contributing to the SUD recovery and behavioral health of their affiliates. One example of community-based initiatives is the FACTS (Faith ACTions for Sobriety) Ministries (pseudonym) that was established in 2000 in a high poverty neighborhood in a Midwestern city (Price-Spratlen, 2022; see also Boeri, 2018; Brave; Heart, 2003; Skoog, 2016; Valentine et al., 2016). It grew from hosting a weekly Sunday service in a backalley garage, to a 3,000 square feet brick, storefront building. Over time, its leadership and affiliates established and sustained community-based health-related services across five health domains (substance use recovery, pastoral mental health counseling, nutritional meal-based support, preventive youth development, other resilience resources [e.g., health screenings, health referrals]) and collaborations with multiple other local health providers. It has largely been sustained through the collaborative charity of multiple, predominantly White, suburban churches and other local, philanthropic, faith-based funding. While a detailed analysis of the Ministries, its mission, and patterns of change over time has been presented elsewhere (Price-Spratlen, 2022), this paper addresses a portion of the Ministries’ mission through a single collaboration of SUD recovery services. For over 15 years, the FACTS Ministries hosted two topic discussion meetings of Cocaine Anonymous (CA) each week. CA is one-tenth the size of Narcotics Anonymous (NA), one-hundredth the size of Alcoholics Anonymous (AA), and has the highest percentage of people of color in its membership and leadership (Laudet, 2008).

The peer-based, 12-Step meeting model and practice has existed for nearly a century; yet little is understood about its process of topical engagement regarding emotional regulation. Research suggests that “we can begin to appreciate addiction recovery as being like a condition of prolonged or pathological grief [to] understand grief and addiction recovery as quite similar and interlinked processes” (Chambers & Sue, 2017, p. 464, 466). How narratives of grief and healing matter in the rooms of recovery is an important area for future and present research. These interlinked processes are explored to understand how they contribute to a social ecology of resilience in a faith-based community health organization.

Literature review

Recent research has analyzed the relationship between grief and SUD (Davis, 1999; Feigelman et al., 2011; Skoog, 2016; Valentine et al., 2016). It shows that grief is present and consequential in clients’ lives since those “entering recovery have to deal not only with giving up the substance, but also with encountering unresolved grief from previous losses” (Furr et al., 2015, p. 46). It informs how therapeutic alliances form among those with SUD, given “the social preconditions of the group members [which] can influence group cohesion [and] later on make change possible” (von Greiff et al., 2019, p. 69). From the 1980s forward, responding to grief in SUD recovery has been recognized as an important part of shared healing. Friedman (1984, p. 65) noted, “The alcoholic (and any grieving person) needs to have his feelings validated – to know that their feelings are real, normal and expected. Encourage the client to explore his feelings and assist, if necessary, in assigning them meaning.” For many, “helping patients mourn what are often tremendous and irreplaceable losses to their health, relationships, and occupational aspirations caused directly by addiction is often critical to protecting them against future relapses” (Chambers & Sue, 2017, p. 466).

It has been shown that “inherent in traumatic events can be losses of both a concrete nature (e.g., people, possessions, places, safety) and an abstract nature (e.g., self-esteem, self-respect, self-worth)” (Furr et al., 2015, p. 44). These may include the “loss of relationships, job and financial losses, physical losses associated with memory and health, and loss of a part of self (e.g., confidence and self-respect) have been identified as losses faced by individuals addicted to substances” (Furr et al., 2015, p. 45). In addition to these more immediately personal losses, historical trauma and its related unresolved grief have been proposed as contributing to substance use problems among indigenous peoples of the Americas (Brave Heart, 2003). Whatever their form, these possible instigators of grief are prevalent among those with SUD.

In the case of those not yet in recovery, “83.2% of all participants stated that, after suffering [a] loss, they increased drug consumption. 12.3% of the patients who first increased drug consumption and after suffered the loss of a significant person reported a relapse after the loss” (Masferrer et al., 2015, p. 23). Among those in recovery, many relapsed, or returned to active addiction, after a grief-initiating event occurs. As a result, “losing a significant person was perceived as a risk factor to increase drug consumption, especially among those participants who first increased drug consumption and after suffered the loss” (Masferrer et al., 2015, p. 28). While “the immediate goal of treatment is to stop all drug use and joining a self-help group such as Cocaine Anonymous (CA) is strongly encouraged [to help] establish a commitment to total abstinence … and form an initial support network” (Harris, 1986, p. 267) that can help sustain that commitment. Through that affiliation, trust is developed and earned to the degree that sharing various vulnerabilities can be understood and appreciated as strengths; as something that assists the person speaking and others in the empathy toward what is being shared.

Increased fentanyl in cocaine-based substance production and consumption has made cocaine use riskier (Nolan et al., 2019). Cocaine use has been decreasing from 2002 to 2019 among US teens and young adults, yet has also increased in recent years among other age groups (Substance Abuse and Mental Health Services Administration SAMSHA, 2020). Alarmingly, the largest increases are among older US adults (John & Wu, 2017). Yet amidst these challenging trends, during the same period, CA meetings at the FACTS Ministries were guided by the discussion meeting format from the CA World Services Manual (Cocaine Anonymous, 2020). As a 12-Step fellowship, “the 12-step recovery program is predicated on abstinence from … all substances of abuse. The program encourages members to look outside themselves for strength (a Higher Power) and to embrace spiritual values and practices that are outlined in the 12 steps themselves. The suggested recovery program includes meeting attendance and participation in ‘recovery work’ often referred to in the scientific literature as 12-step ‘involvement’ or ‘affiliation.’” (Laudet, 2008, p. 6).

Though not formal therapy, 12-Step meetings in general, and CA meetings in particular, are therapeutic. Given their therapeutic character, “a core strategy of grief therapy to facilitate growth of the individual into new healthy preoccupations, habits, and relationships is also critical to addiction recovery” (Chambers & Sue, 2017, p. 467). As healthcare providers are increasingly recognizing, “Grief is a healing journey we travel [to get] back to wholeness. Understanding this process and the intense emotions that can accompany it may help you move toward a healthy recovery … [as you] work through those painful parts of grief and heal [to] become stronger and more compassionate people” (Permanente, 2018, p. 4). CA meetings at the FACTS Ministries were a setting where such healing journeys occurred regularly.

As noted by Price-Spratlen (2022, p. 14), “Prior research has described and explained active addiction in great detail, [yet] far less well understood are individual and organizational components that make up a social ecology of resilience for long-term recovery.” As previously noted, “continued research is needed on the types of losses experienced, the impact of these losses on recovery [and] the effectiveness of addressing losses that enhance the recovery process” (Furr et al., 2015, p. 54). In short, we know too little about how grief is processed in the rooms of SUD recovery given its demonstrated significance. What healing environment emerges from the sharing, both for the person who shared about their mourning and for others in attendance? This and related questions are answered in the analyses that follow.

Data and methods

These data are a part of a larger, multi-year organizational ethnography of the FACTS Ministries and its organizational and health-affirming collaborations (Price-Spratlen, 2022). Human Subjects approval of this project’s adherence to all ethical and institutional protocols for all data collections was secured under the project title, “Sober Turning Points in an ‘Imprisoned Community’” (Ohio State University Institutional Review Board approval, 2013B0418). The FACTS Ministries was founded “by returning citizens in long-term recovery [as] a faith-based, urban recovery and health organization” (Price-Spratlen, 2022, p. 3, 19). When it first opened its doors, it was often a topic of local curiosity and derision. It moved from a backalley garage to a small building on Akron Avenue, the main street of that area of the city. That portion of the street was known as a church corridor, given the fourteen churches that were in a two mile stretch of road. Through its name and other symbolic imaging (e.g., a line under the large bold letters of the organization’s name on the front of the building read, “a space where those in addiction come to heal”), the leadership chose to call attention to substance use in a way that seemed to make many neighbors uncomfortable. This, even as it was known by residents throughout the city and beyond its borders reputationally as an area of visible drug sales, trap houses, and sex industry. The larger project included over 2,500 hours of participant-observation to the five primary domains of health-related services, over more than fourteen years. Data collection at the Ministries took place at the “church side” (i.e., the chapel, pastor’s office, audio-visual support corner and the men’s bathroom), and the “community room” side which included a large, open room, a small kitchen area, and the women’s bathroom.

In the community room side of the organization, 12-Step recovery meetings were hosted twice a week. Because of the prevalence of, and concerns for, the use of crack cocaine at the time, leadership of the FACTS Ministries approached the local chapter of Cocaine Anonymous (CA). CA is not a drug-specific fellowship and according to its Step 1, it is open to all those with any SUD, specifically “cocaine and all other mind-altering substances” (Cocaine Anonymous World Services, 2020, p. 6). Soon, on Thursday nights and Saturday mornings, a small number of affiliates of the church side of the Ministries began meeting with a few members of the local chapter of CA; and soon, both meetings grew. Together, they named the meetings “Either-Or,” “as a reminder of the sober choice people in recovery make one day at a time [either to nurture] the opportunity to achieve and share the resilience of sustained abstinence with others” (Price-Spratlen, 2022, p. 38), or to risk returning to active addiction. The chair of these meetings would solicit three topics for discussion. Topics included: family or work-related stresses; concepts from the “Big Book;” concerns about the relationship between recovery and spiritual growth; community or current events in relation to one’s sobriety; and topics of mental and physical health, including those of grief, rage, and other emotional depth and consequence.

The data used were collected in Either-Or CA meetings during three periods: 32 meetings between June-September 2011, 36 meetings between March-June 2013, and 34 meetings between August-November 2016. These 102 meetings across years accounted for some seasonal variations (e.g., the number of people coming to the meetings, patterns of participation from those in attendance, topics suggested). To document experiences of how grief was expressed and engaged with at these meetings, 90 total topic meetings occurred across the 50 project weeks in which diverse ways grief showed up were discussed. Soon after a meeting ended, the researcher logged the topics and noted the content, themes, and select quotes of individual attendee shares.

These data were analyzed through an iterative process by the author and a trusted person in recovery who was affiliated with, and appreciated the mission of, the Ministries. Consistent with Sweeney et al. (2013), the author collaborated with this health service recipient and researcher, and “through the process of multiple coding, [we] were able to build strong consensus about the data from multiple perspectives” (Sweeney et al., 2013, p. e89). First, we coded and grouped the topics independently to specify an initial list of emergent themes. Second, we met and discussed why we perceived the theme groups to be a credible and quality summary of the topics. Third, we each independently “mind mapped” the themes as we understood them as the final stage of thematic refinement. Mind maps are “a diagram used to represent concepts, ideas or tasks linked to and arranged radially around a central key word or idea. Within health services mind maps have been found to be [a] useful tool for ensuring the broad range of views are represented, with the aim of reaching a common understanding” (Burgess-Allen & Owen-Smith, 2010, p. 407). This approach is similar to “the hierarchical frameworks of codes and categories created by qualitative data management software packages” (Burgess-Allen & Owen-Smith, 2010, p. 408). We then met to enrich consensus which generated the findings presented here. Similar to the process of moving from open coding, to axial coding, toward thematic specification (Berg, 2001), mind mapping helped us refine and finalize the thematic overlap presented here (Sweeney et al., 2013).

Findings

From the meetings, 258 total topics were suggested. Approximately 61% of the topics were not repeated, leading to 157 unique topics. Of these, approximately 28% were grief-related. That led to 45 grief-related discussion topics. Just as “developmental grief comprises a full spectrum of emotions” (Tukhareli, 2011, p. 4), grief narratives in the rooms of recovery also reflect a spectrum. The recovery-informed grief spectrum which emerged from these Cocaine Anonymous meetings had five themes: Prior Lives, Possible Lives: 16 (36%); Parenting Paradoxes 10 (22%); Overdose Proximities: 6 (14%); Loved One’s Passings: 5 (12%); Others (Community violence, public figures, pets, combinations, etc.): 8 (16%). This topical diversity extended from a demographic diversity among those in attendance. Like the number of persons in any given meeting, which ranged from five to 32, other diversities also fluctuated. Still, the meetings tended to be predominantly African American, male, in their 40s and 50s, employed, and experiencing relationship and other instabilities over time. Grief-initiating experiences discussed ranged from the death of an elderly loved one that occurred during childhood, to the shooting or overdose death of relatives that had happened while the attendee was in recovery, just days before their shared reflection.

Prior lives, possible lives

This most frequent category of grief was expressed by those that mourned lives that had not been lived, due to lost years living in what one meeting attendee described as a “chaos spin cycle” of active addiction. Often associated with the criminal justice system, these attendee shares addressed economic, geographic, or other mobility opportunities not pursued, or were otherwise soiled or withdrawn, relationships that were ruined or otherwise abandoned by the speaker, or other mournful laments of lost opportunity.

Avril was in his mid-30s and was currently serving time in the Community Corrections Facility (CCF) (these two and all other personal and organizational names in the article are pseudonyms). CCF functioned as a “halfway back” minimum security setting that afforded those incarcerated to community access. These “prison diversion residential programs … promote community safety by providing … skills to deal with drug and alcohol addiction and to change criminal behavior” (corjusohio.org/community-corrections/, 2016; see also Bernard Cora et al., 2020). As part of their prison diversion, CCF affiliates were allowed to attend community activities of various kinds, so long as they returned to the CCF institution before their curfew and abstained from all substance use. Women CCF affiliates attended Thursday night meetings, and male CCF affiliates attended Saturday morning meetings. When Avril was about a month away from his release, he said:

Thing about it is, it was always about that New Jack City life you keep thinkin’ on, where you the one callin’ the shots, and makin’ things move. All that shot callin’ sh – that ain’t nothin’ like the movies. The dream for real was the come up. But the come up wadn’t happenin.’ Too many things got lost. Too many folk to climb over. And never enough product, and never enough folk comin’ to the door, to make it ova’ all of “em. Competition in sports and all that? Sh – Try makin” the game work for ya. Too many maybes (long pause; began to cry). Not to be. So I’m here. Startin’ ova, one more time.

Here, Avril’s grief was in the longing for more success when he was selling drugs and all that went with lamenting the “come up” that never came. Carceral complications were many, often extending from grief about a life “in the game” of substance sales, more than for the loss of any civilian life in everyday community. This mourning was often intensified when other losses occurred in community while serving time in jail or prison.

When Marvin, now in his 40s got his “third number,” by going to prison for the third time, his marriage of nearly ten years abruptly ended, stunted as it had been with his prior cycle of incarceration. His response to these losses was grief and an unsteady sobriety.

That f—ed me up, for real. Second time out, I was good. We was good. Didn’t creep on her (i.e., did not sleep with other women). Had a W-2 job, most of the time. The whole nine. Got caught up in a sting when all that happened up in [area of the city known for drug activity]. Wadn’t even “sposed to be there. My second was ‘sposed to make that connect. Got clipped. Now look at me. Wifey gone. Car gone. Even my brother and my mama bein’ sometimey, for real. (long pause). Jus” not sure how this one’s gonna go.

Marvin’s share was greeted with knowing head nods, especially among the men. Some openly acknowledged that relationships soiled by the active addiction of the speaker were often driven by the grief of recovery’s recollections of absence, from life circumstances of stunted relationship building. Also, the memory of all one had built – “even the good parts” – was often recalled as a lie or illusion, or the circumstances of a person quite different from the one they were becoming, while living the resilience of a now sober self. This is the process of repeated anguish at these Ministries meetings, as “irretrievable loss. The transformation of the world is [an] alteration of the subject, who becomes a riddle to himself and, in a sense, does not recognize himself anymore” (Fuchs, 2018, p. 44). For many, the riddle was gradually resolved as resilience was initiated most often beginning with CA meeting moments following their grief share. Empathy was expressed as others in attendance recounted similar experiences.

April, African American, in her late 40s, had gotten sober soon after her 40^th birthday. Her 20s and 30s were ripe with various success markers. She worked for the state and had created a life of upward mobility well-beyond her humble beginnings, complete with a graduate degree, a college educated child, and success in middle management for an agency. Yet for her, a common lament was mourning for the person she knew was in her and was never realized.

I’m working. Never didn’t work. All that “high bottom” stuff about not having to lose the job, the house, and end up in a tent somewhere. None of that was my story. Still, there’s the shadow of the life that never was. The other degree I never pursued. Leadership opportunities and making meaningful policy decisions on a daily basis. The houses I intended to flip but never did. The investments I was supposed to make. Putting my kid in that “elite” private, from K through 12 and on. The husband that … (long pause; tears followed, along with a change of subject) My life is good. Real good. Has been. Is. And I am grateful. So, this is my life. So much more than just settling. My Grace has me. Knowin’ that makes all the difference, even with the pain.

Like many, April concluded her share with a turn toward an affirmation of her faith. Her resilience was being built through her experience(s) of an open dialogue with The Promises of the Ninth Step that states “We are going to know a new freedom and a new happiness. We will not regret the past, nor wish to shut the door on it. We will comprehend the word serenity, and we will know peace” (Alcoholics Anonymous, 2001, pp. 83–84). Resilience is in the doing of one’s necessary amends and other stepwork to “make right” the wrongs one did to others.

By making amends to those one has harmed prior to becoming sober, the resilience of The Ninth Step Promises is realized by not regretting the past, nor wishing to shut the door on it. By doing so, the CA member is able to know a new freedom and new happiness, and comprehend the word “serenity” and know peace. Realized resilience is both the action and the outcome. Faith actions of making right are the “work” or working the steps, and the means by which The Promises manifest from stated affirmation into truth. For many, expressing the griefs of prior lives, possible lives at Either-Or meetings, was a valued part of the recovery process.

Parenting paradoxes

The next most frequently discussed grief-related theme was parenting tensions. These included: custody tensions, actions by Child Protective Services (CPS), and navigating child endangerment assessments, the foster care system, or other family members. At times, discussions were about how these processes were informed by LGBTQ identity and altered access extending from what the parent perceived as sexual identity discriminations.

While in active addiction, Lauren, white, mid-30s and living in a working class near-suburb of the city, had her three pre-teen children removed from her custody by the state due to multiple calls to CPS that had been received about them from one or more neighbors. Two of her children were placed into the custody of their father, from whom she was estranged. Her youngest was being raised by her mother. She had been referred to the Ministries by a member of her church who, as Lauren put it, “had heard about a place where the faithwalk of footsteps could be sober once more.” Sharing a depth of grief only partially reflected here words below.

I love my kids. I would move the world if I [could] get them back. I’m their mother. I am! (She paused, growing angry, barely able to speak through her tears). Now I may not be able to even share custody?! The two eldest might be adopted right out from under me. I’ll be as sober as I have to be to get my kids back.

When Lauren spoke, like many meeting attendees, she was in a dialogue with unseen institutional actors who had the power to impose hardship beyond shame. Shame often resulted from the stigma of what they experienced as largely inaccurate or incomplete judgments of “parental fitness” and an enduring love. Reggie, African American and in his 40s, was a father of two children, now in their early teens. He had missed much of their early years out of state, striving to build business opportunities that never panned out, and then in prison for two short sentences through his 30s. As a result, even when he was in community, he was not “fully” or even regularly in his sons’ lives. In addition, Reggie spent two other brief periods in county jail for relatively brief periods of time, though they were disruptive, and were meaningfully long for his sons, especially his eldest son who was named after him.

Junior still hates me for all that. Much of the time, he can barely look at me, and seems to have someplace else to go when I’m able to come around now. Thank God the youngest doesn’t seem to feel the same. And thank God for real, that my ex never badmouthed me too too bad with the boys. Still, my eldest can’t see his way to a place where I’m not the villain. I believe my God has forgiven me. When one of your kids does not, it makes that loss, the could have been, kinda brutal.

For Reggie and many parents like him, their grief process is profound. Almost half of incarcerated men are fathers, and among women in prison, nearly 60% are mothers, as are upwards of 80% of women who are jailed (Ocen, 2018).

Aisha was a mother of two who had recently affiliated with the CA meetings at the Ministries during the final four months of her sentence in CCF. She was among the very few CCF affiliates who had any family member attend meetings to support them. Because the meetings were “open,” meaning anyone who chose to could attend, others besides those with SUD attended and participated though those not in recovery attended very rarely. Her long-term partner, who was not in recovery, came to the meetings and stated that she “never had a quarrel with alcohol or drugs, but I’ll do what I need to to support Aisha.” Though usually quite guarded, through her growing trust with regularly attending affiliates at that meeting, she once shared that:

The thing that is still so painful is how CPS came at my family. Even when I was at my worst [in active addiction], those kids were never hungry. They were never not in school. They never didn’t have the clothes and pencils and whatever for they school stuff. Still they came for my neck. That was the real trauma on them kids. Tellin’ me I’ma danger, and unfit and all. Naw, they was wrong for that.

Aisha implied that rearing children and whatever her active addiction may have been doing to them in the eyes of the state did not warrant the severity of the CPS/state response her family experienced. For Aisha, her solace seemed to be that her grief was equal parts mourning and rage. In the meetings, the couple’s lesbian identity was an open secret. This is quite consistent with other predominantly Black faith settings where “the prevailing culture is still one of silence, repression, denial, miseducation, and misinformation” (Pollard, 2004, p. 315, 316). At the time of Aisha’s pending release, the state was attempting to place both children into foster care. The author was unable to confirm the outcome of her family effort toward sustained custody.

Overdose proximities

The two rarest grief themes were also the most severe. They directly involved the risk of death and actual deaths. The shares in the meeting when the reflection was being spoken tended to be longer. The likelihood of raised voices was greater, as was the emotional intensity, with tissues and tears, through gritted teeth of rage. Also, when a person shared about someone’s death or near-death experience, compared to any other expressions of grief beyond regret, they were much more likely to “take over a meeting” by sharing for a length of time well-beyond what was typical. When death was the focus, those rules were often suspended (Price-Spratlen, 2022). It was in these moments where the sense of “testimony” in the Black church tradition often occurred (Davis, 1999; Pollard, 2004). The call and response of others in attendance invoking church tradition with phrases like, “It’s alright, baby. Take your time” occurred quite often. And the symbolisms and behavior of a laying on of hands to invoke the spirit of the Lord’s touch shared between the children of God often took place. The program of Cocaine Anonymous, like all 12-Step fellowships, is a spiritual program, not a set of religious rituals. Still, invoking religious traditions to demonstrate a strong sense of care was commonly used. On several occasions across the data collection periods, mourning was expressed associated with the overdose of someone one knew and with whom one had gotten high.

The moment closest to a parent losing a child to overdose was the experience of Warren Pomely, who was a church attendee of the Ministries. Though he did not come to the Either-Or CA meetings at the Ministries, Mr. Pomely described himself as “a drunken sailor, saved by Grace.” He had been sober for 17 years when his 40-year-old son drove after drinking and died in a one-car accident. On the following Saturday, Mr. Pomely was at the Ministries as the CA meeting began, and he chose to stay and participate. As he recounted,

My son was killed by a drunk driver. What’s really heavy on my heart is that he was the drunk driver … . How does that affect someone in recovery? Is that discouraging? Well, ya. I’m not mad at my son, at all. I believe my son was saved, and just made a bad choice. [Then just] weeks after my son was killed, I did something no one expected. After 17 years sober, I went out and I got drunk. (Price-Spratlen, 2022, p. 33)

Mr. Pomely’s relapse was short-lived. Within a week, he returned to church attendance at the Ministries and to his sobriety. Mr. Pomely was welcomed into the meeting, as were all newcomers. As his grief resonated deeply, many responses to it including and well-beyond shared sorrow for his loss, were repeated by all who spoke after his share ended. As Friedman (1984, p. 64) noted years ago, “Relapse factors pertaining to the individual should be identified so that mechanisms for coping with the[m] can be developed.”

Terrance, in his 40s and working for the state, recounted a situation similar to one he witnessed in his active addiction. The situation that resonated with many affiliates remains a valued image of how someone else’s grief can reinforce a commitment to their own sobriety and desire to live out Step 12: “to carry this message to addicts, and to practice these principles in all our affairs” (Cocaine Anonymous World Services, 2020, p. 6). He recounted the overdose death of Kadeesha, the daughter of one of his parent’s employees. He said:

As Kadeesha was clearly ODing, her mother, Alice, believes that Kadeesha had been getting high with at least two others. Whatever places our addiction took us to, when others are in the room, the item in control of all decisions and actions is the dope. [Many nodding heads, yes, and several, loud, “Mm, hm” signifying followed]. Ya, it’s all about the sizzle, and who’s holdin’ the dope, for real. Apparently, Kadeesha had some kind of severe reaction. Who knows what other substances were mixed in the dope.

According to Alice, Kadeesha did the whole foaming at the mouth thing. The shakes. Going unconscious. Whoever else was there put her in the bathtub. They likely ran cold water over her, attempting a wake-up cure all. They went back to the dope that was left. Perhaps some CPR was done. Whatever. No one called down to the front desk. No one called 911. The person who found Kadeesha’s body was the cleaning lady the next afternoon. Kadeesha had died in that tub that night. My Mom told me this because Kadeesha’s mother Alice worked for my parents. Not much of Alice’s intended work got done that day. My Mom sat with Alice. Talked her through some things. Did some grief counseling stuff, a bit. Black mom to Black mom. It was a start. A situation I was in like that helped slap me toward my bottom. The dope doesn’t care. The crime remains unsolved. Hearing the grief in my mother’s voice helped me realize how deeply Alice had been mourning for her daughter, and how much fear my Mom had lived in with me.

This moment of a mother being a grief witness resonated with many. It shaped the empathy of Terrance’s recognition of how easily such a moment could have been his own death, and his gratitude that it was not. In those CA meetings, grief often resonated toward resilience even when it extended from the death of a stranger, shared second hand.

As has been noted in earlier research, “although the subject of overdose deaths appears to attract substantial attention among the public-at-large and from epidemiologists, surprisingly, it has sparked scant interest among bereavement researchers” (Feigelman et al., 2011, p. 292). Be they warnings or anticipations of yet-to-be-grief that is feared, or the empathic language that shared motherhood bridges, or something else, grief at the Ministries, and in SUD recovery more generally, is often about words that are not spoken, but are strongly implied.

A loved one’s passing

The most resonant grief in the rooms of Either-Or CA meetings and in general, was the death of a loved one. The most poignant among those was that of a parent who had lost a child. Roman, in his mid-50s, African American with a thick, southern drawl, was introduced to these CA meetings and the Ministries itself in a late fall meeting on Saturday morning. He had been referred to the Ministries by a Salvation Army staff member who had attended church services months earlier. New to town, homeless, and in search of a safe space to build on his sobriety, Roman arrived at the meeting wearing a basketball jersey of a rival state institution of the place where the Ministries was located. On the verge of tears that seemed to bely his appearance and presentation of self, he recounted his place of present grief. His son had recently been shot in a small southern town a few miles from Roman’s home.

I could say he was raised up in the game and all “at. I could talk about what he knew and why I lef” outta there, ‘cause all “at was about to run up on me. I could talk about all the talks I had with his mama, and how she and we not bein” together didn’t mean he had to go out a seek out those folk in the game. I could tell you “bout how he lost an uncle when he was real young, but old enough to remember his grandmama’s tears. I could tell you ‘bout how I was away for awhile [in prison] and how that hurt him real bad. None of all that stoppin’ a bullet. None of all that kept him from that corner and that argument, and what it was over. None of that gonna bring my son back. My baby boy that I gotta go back South and put in da” ground. (long pause; intense tears). Glad I found y’all. Glad all y’all was here this morning. But I want my son back. I wants my son back, real bad.

Roman’s share was followed by one among the longest shared silences of any event of any kind at the Ministries. The silence was a demonstration of respect, with no one wanting to in any way take away from the heartfelt depth of Roman’s anguish. During the remainder of the meeting, no other topic was addressed. All the shares that followed addressed examples of the most painful loss others had experienced, or expressing condolences to Roman. Each share was presented with impassioned empathy, and an abiding appreciation for the strength of vulnerability and emotional honesty Roman had shared with a room full of strangers to follow. And they did.

Other sources of grief

There were other topics of mourning beyond these four themes. The deaths of pets from childhood resonated and was repeated as one among the most salient developmental experiences of grief. Reactions to the deaths of public figures whose death was informed by alcohol and drugs also resonated, with those in meetings sometimes openly weeping at the mention of Whitney Houston’s death, or Kurt Cobain, or others. These passings seemed to resonate as reminders that even fame and fortune was in no way protection from active addiction and could in fact make one’s risks much greater. Such deaths seemed to affirm the value of having a program of recovery available, regardless of one’s social class, made clearer by other public figures who are open with their sobriety. Reactions to community violence were also deeply meaningful prompts for the recounting of grief valued by others.

Building resilience

Navigating grief in longterm recovery from substance use is a process of resilience. By fostering a healing social ecology, CA meetings hosted at the FACTS Ministries and in other “community health organizations can make a valuable difference in sustaining health and resilience” both in, and well-beyond the lives of its affiliates (Price-Spratlen, 2022, p. 6; see also Boeri, 2018; Hughes et al., 2020; Thompson & Cox, 2017; Ungar et al., 2013). Resilience was nurtured in the lives of many affiliates who reflected on grief in the CA meetings. From what was discussed in the Either-Or CA meetings, four building-resilience themes emerged most frequently: a) Communal; b) Careerist; c) Familial; and, d) Fellowship. Each is briefly considered below.

Communal resilience

Ministries affiliates expressed their resilience beyond grief in communal ways. These ranged from volunteering at a neighborhood youth center in response to a community shooting, to supporting a small business daycare center just starting out in response to concerns about infant mortality levels in the community; and from speaking at a homeless shelter where a Ministries affiliate once had stayed, to participating in a tutoring program in memory of someone who overdosed far too young. Douglas was from a small town in a neighboring state and frequently went home. His sponsor still lived in that small town. When his sponsor passed away, Douglas shared lovingly about the many ways his sponsor had contributed to his life, in both marked and small ways:

I will forever be a Don S. devotee. He saved my life in ways I can’t begin to count out loud. I had the shame of being the neighborhood drug addict in a town that small, nobody was going to come to the rescue with the damage I had done. When I finally got sober, Don was there … We had most of our meetings on a park bench in town. So I asked the town manager if it was okay for me to paint the benches. Now, every summer I volunteer with the county team that does that stuff. Don S. is the reason why. Love that man.

Sylvia is a proud and passionate Native American woman in recovery. At Either-Or meetings, she often spoke of, and was respected for, her poignant reflections on the perpetual grief of Native Americans, given the genocidal history of the U.S. toward Native Peoples. Her recovery reflected a resilient awakening that respected that grief, both her own personal, and the macro-historical. It informed the organization with which she was affiliated (e.g., Native American Education Center) and how she raised her two children. She once noted:

My son is going to graduate high school early and join the Air Force. He has excelled in ROTC for several years, and I could not be more proud of him. He understands more each day the mainly hostile ways of war that characterize the wounds he carries as a First Nation male. He and we will explore how to reconcile as our wounds continue to heal.

Whether being of service by painting park benches in a small town, or the civic commitments of countering generational trauma to further one’s ethnoracial history, communal resilience was displayed in such contributions to the community beyond the rooms of recovery. The “living amends” of their actions of remembrance exemplified how their bouncing back from grief was through sacrifice of time and care, much beyond the single bench where the two had life-saving exchanges of 12-step work and the Ancestral honoring of one’s group in their lives of recovery.

Careerist resilience

Several Either-Or meeting affiliates displayed their resilience as a growth-beyond-grief process in quiet ways of vocational change. Teddy was a Vietnam-era veteran who had bounced around the health field for many years after his return from active duty. He openly spoke of how he had gotten addicted to many things during his tours in Vietnam and his many battle scars that lingered, with longstanding grief being one among them. In his 60s, Teddy went back to school and became a nurse. For him, this was an act of solace and service for the many men with whom he had served who did not return home.

All the movies and speeches, Platoon, or Coming Home, or Bloods, or whatever, all that are just a start. We will always be coming to terms with that unwanted war. Meanwhile, those of us who were the grunts on the ground saw terror that all that Hollywood stuff only begins to show. When you look into the eyes of a buddy with half their insides on the ground next to them … [voice trails] A bunch of stuff you can never unsee. For me and many others, finding minutes of distance in cheap and easy dope was helpful for whatever sanity we could have, those few minutes at a time. I’m not sure I’ll ever be sane again. The nurses and medtechs and all that did the best they could. I am not a nurse by accident. Not sure how much it matters. But it’s what I can do.

Teddy’s career choice to be a nurse later in his life exemplified a career-based resilience built from an unresolved grief from military service that had sustained his addiction. He reflected openly about PTSD and “battle scars that no one else can see,” and those “who came back crazy and couldn’t stay out of the rubber room,” and the many ways of death they came to know. All the challenges of reactions back in the U.S. made the process and the memories more confusing. His addiction recovery was one way of making sense of it all. Like Teddy, Darryl’s developmental history also shaped how his grief informed his resilience. Darryl had carpentry and auto repair skills he had learned from his grandfather who passed away when he was in his early 20s. He did carpentry and auto repair “pro bono” for those on fixed incomes or other money challenges, charging only for parts and materials and “what people were willing and able to pay.” His memory of his grandfather’s Good Works remained special to him, and this affiliate’s services were a welcome communal and careerist asset.

Familial resilience

Equally frequent among CA meetings affiliates were the family contributions beyond mourning. Similar to Sylvia profiled above, Jackson was also informed by “Ancestral echoes;” that of his father. Jackson is a father of two children, African American, in his late 30s and a municipal employee for the city. Jackson’s father passed away when Jackson was a young adult and many years before he got sober. The burden of his father’s passing was made more challenging by what appears to be the brusk and largely inaccessible style of fatherhood Jackson’s father displayed. In his shares Jackson used adjectives like “cold” and “distant” in referencing his father. His grief in relation to the challenging love of his “ol” school” father led Jackson to choose to be more available and warmer toward his children as he could be.

That’s the gift. My kids have never seen me drunk or high. Not ever. And they are much more than some off time products of a rehab romance (a short-term relationship that is the product of having sex with someone one met in treatment for SUD). I am as active as I can be in their lives so that they will know both that I love them, and how love can be shared with them. This is the least I can do to be there for them as best I can. Coachin’ ‘em up in a bunch of sports. Every school event. Parent-teacher conferences, every drop of possibility. They are my sober Blessing.

Jackson had made numerous career sacrifices, both large and small, to hold himself to that high standard of Black fatherhood. His grief from his own father’s death when Jackson was young, was a motive for him doing so. His resilience beyond his grief was also motivated by regret that his sons never had the opportunity to meet their grandfather.

Fellowship resilience

In a program of action, grief motives and the resilience extending from them, are much more than feelings alone. In addition to their regular attendance at the Either-Or CA meetings, Aisha, Reggie, Terrance, and Lauren were among the more active members of the local chapter of Cocaine Anonymous. For them, being of service was both expected by their sponsors, and appeared to be a strong, grief-informed desire that each valued. Consistent with their understanding of grief and addiction recovery as interlinked processes (Chambers & Sue, 2017), they lived their lives through fellowship service beyond mourning. This was among the aspects of their recovery they appeared to value most. Theirs was an active building of resilience, recognizing that “one of the keys to successful recovery is getting involved. Begin by taking on the tasks and keeping commitments [to] help yourself by helping others” (Cocaine Anonymous World Services, 2020, p. xviii).

For example, Reggie sponsored many men in recovery, was a GSR (Group Service Representative), and active in H&I, the Hospitals and Institutions committee of the local CA chapter. He chaired a weekly CA meeting at a nearby state prison. His grief for the lost years he spent locked up never left him. However, he valued those years spent in prison as the motive for bringing others currently incarcerated into an understanding of their sober selves. Lauren valued serving as treasurer for the local CA chapter. Her resilience was built through the bounce back of sound money management that allowed her to make the most of her resources to gift her children “the childhood I hope they can look back on with appreciation.” For Lauren and Reggie, many tensions of contested parenting remained, for which their programs of CA recovery were helpful. Like other affiliates, those tensions and their grief never immobilized them, and their fellowship service was an important part of their healing and resilience.

Aisha co-hosted a detox meeting at a treatment center open to women in the first hours of their treatment toward longterm recovery. She represented CA for those who had been most recently transferred to the treatment facility from the county street detox unit, hospital emergency rooms, and local drug courts for those whose treatment was court ordered. She helped those currently incarcerated to “know a new freedom” (Alcoholics Anonymous, 2001, p. 83), by being of service to the local CA chapter, or simply reading one of the approved readings used to begin a CA meeting. Terrance “dabbled in the art of recovery” as he described it, doing a bit of each of these things. The loss of his uncle at a young age to active addiction is among the grief memories that seemed to grow more vivid as he aged. The service helped him care for the kid within him who missed his uncle.

Discussion and conclusions

Like the recently published, Hope Faith & Courage, Volume II (Cocaine Anonymous World Services, 2020), The Twelve Steps and Twelve Traditions (1981), and the Big Book of Alcoholics Anonymous, are also among the approved literature for the growth and learning of recovery in Cocaine Anonymous. A person in recovery using this literature is asked if they can “accept poverty, sickness, loneliness, and bereavement with courage and serenity?” (Alcoholics Anonymous, 1981, p. 112). In this question, the framers of the 12-Step model acknowledge the importance of bringing together some among the most challenging life circumstances that could place one’s commitment to, and life of, sobriety at greatest risk. Of them, bereavement is listed last. Perhaps this was done to signify it as the most challenging among them. Courage and serenity are presented as the primary means of engaging the resilience toward long-term sobriety. To mourn, to know grief, engage with it in the rooms of a 12-Step fellowship is among the most salient acts of courage one can demonstrate in the process of long-term SUD recovery. As these Either-Or CA meeting affiliates and this analysis of their narratives help show, this is a process of “the educational variety [of] “a spiritual experience” (Alcoholics Anonymous, 2001, p. 567) beneficial to the growth that a social ecology of resilience affords. Such was the case of grief engagements at the two CA meetings hosted at the FACTS Ministries.

Community-based health initiatives provide therapeutic and preventive resources for SUD care. They help to reduce SUD and marked race and ethnic disparities in SUD treatment access. By doing so, they also help improve and sustain community health. 12-Step organizations have collaborated with these health initiatives for some time. Yet little is known about how Cocaine Anonymous contributes, and how the grief experience within longterm recovery informs the resilience of its affiliates. In the rooms of SUD recovery and at CA meetings hosted at the FACTS Ministries over the years, grief was expressed through several diverse themes and enriched multiple forms of resilience. In the CA meetings shares, grief was shown to contribute to healing others, as those who shared contributed to their own healing. Grief was experienced by, and expressed through, affiliates of the two CA meetings, along the main thematic lines considered here. Each theme uniquely enriched the social ecology of resilience.

As noted in the Twelve and Twelve (1981, p. 105), those using the 12 Steps in their recovery “will also report that out of every season of grief or suffering, when the hand of God seemed heavy or even unjust, new lessons for living were learned [as] new resources of courage were uncovered.” Building resilience from grief in SUD recovery is a process of intentioned transformation. The 12 Steps are a means by which these transformations are built, akin to “The Transformation of Silence into Language and Action.” This essay by Audre Lorde from Sister Outsider (Lorde, 1984) ends with a vital affirmation of how transformation can unfold. As Lorde (1984, p. 44) noted, “The fact that we are here and that I speak these words is an attempt to break that silence and bridge some of those differences between us, for it is not difference which immobilizes us, but silence. And there are so many silences to be broken” (Lorde, 1984, p. 44). The transformations of grief into growth and resilience has been shown to help individuals heal by doing much more than engage in morbid recitations that say little and help less. Instead, these sharings at CA meetings helped those in attendance to heal.

These findings show how diverse themes of grief emerge in the rooms of recovery and how they lead to building resilience. Possible lives tended to consistently resonate less severely than the others. Along the relative continuum of grief severity, parental losses seemed to only be superseded by the death of a child. The impact of overdose proximities perhaps was between them, resonating less severely than the seemingly greatest anguish of a loved one’s passing. Qualitative severity indicators included the apparent intensity of emotional distress the speaker seemed to be in as they presented their grief share, the number of times they had to pause, as their emotions and tears made it difficult to speak, and the number of those in attendance who chose to then empathetically share their own experiences with respect. Regardless of the degree of severity, a possible growth toward resilience appeared to occur quite frequently. In these meetings, statements of grief were conveniently stated and exchanged in grief-stricken moments, like the glide of a duck on water. As in the duck’s movements, much more resilient growth appeared to be taking place below the surface presented in the words of a meeting’s share. These are the forms of resilience used to meet with mourning, respond to its arrival with respect, while not retreating from it, or being overwhelmed by it. Beyond the meeting shares, other forms of resilience often follow if a “good program” of sustained sobriety is to be maintained.

These forms of resilience that followed appear to have often served as facilitators of growth while this growth toward resilience included healthy ways of feeling connected to the loss, giving the loss meaning, exploring what, if anything, may have been gained from the loss, and other means of promoting adaptive progression with, and beyond, the present pain (see Hill et al., 2019). In these shares, expressing immediate anguish often demonstrated to that person that they were not alone in their experiences. Others then gave meaning to a growth “beyond” grief, and within a healing toward resilience. These included diverse examples of respecting grief and expressing a dialogue of change. Verbal empathy in the meetings immediately after a grief share is an important means of a formative resilience. Empathy was often expressed with a caring humility, a recognition that there are many unknowns associated with the moment of grief the person is experiencing, and that a search for assurances is far less fruitful than a recognition that the dialogue of change of the 12 Steps and the fellowship associated with it provide a means by which the grief unknowns can be navigated successfully.

The resilience was demonstrated in the examples others used to show how their PTSD, or wounds that remain from the grieving of losses experienced earlier, was manageable and a means through which their sobriety had often been enriched. Most often the person speaking had remained sober despite the intensities of their grief, however severe, however enduring. Others in attendance most often spoke of how they valued using the tools of recovery to do so (e.g., approved literature, sponsorship, meetings, prayer, being of service to others). Including the CA meetings at the FACTS Ministries, longer-term resilience was consistently demonstrated through communal, careerist, family-building, and fellowship-enriching means. Each seemed to be part of a dialogue with The Promises of the 9^th Step which include: “We’re going to know a new freedom and a new happiness. We will not regret the past nor wish to shut the door on it. We will comprehend the word serenity and we will know peace” (Alcoholics Anonymous, 2001, pp. 83–84). Grief is among those things one is not to wish to shut the door on; by allowing oneself to experience, rather than repress, grief, one can grow into a comprehension of serenity, and a knowing peace. As shown throughout, resilience can then embolden a broader justice, greater equity, and other beneficial opportunities in an environment of shared respect – not as some idealized communal practice, or a hoped-for future well out of reach. Rather, as a necessary call to action in one’s present, where grief need not immobilize someone as another form of silence to be transformed. 12-Step meetings hosted by community-based health initiatives like the FACTS Ministries, have an important role to play among the therapeutic and preventive modalities of SUD care. Grief expressed at these is a part of a social ecology of resilience that is helping to reduce SUD, contribute to healing, and improve individual and community health.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by the Criminal Justice Research Center, Ohio State University [2013TPS].