Louise Stanger is a speaker, educator, licensed clinician, social worker, certified daring way facilitator and interventionist who uses an invitational intervention approach to work with complicated mental health, substance abuse, chronic pain and process addiction clients.
There were more drug-related deaths in 2016 than from the entire Vietnam war or the HIV/Aids epidemic at its height – and for every person who died suddenly and tragically there are at least four or more people directly affected by the loss. These guidelines can support the bereaved.
In the midst of a worldwide alcohol and opioid epidemic, the numbers of families and friends who must deal with the aftermath of traumatic sudden loss is staggering. Josh Katz reported in the New York Times that, in 2016, more people under the age of 50 died from drug-related causes than cancer, war and traffic accidents. In 2016, drug overdoses killed more americans than the 58,000 soldiers who died in the entire Vietnam War… the 55,000 Americans who died of car crashes at their peak in 1972… the 43,000 who died due to HIV-Aids during the epidemic peak in 1995… or the 40,000 who died of guns during the peak of those deaths in 1993 (Vox).
Where the US leads, will others follow? England and Wales registered 3,744 drug poisoning deaths involving both legal and illegal drugs in 2016 – the figures do not include other adverse effects of drugs such as anaphylactic shock, or other types of accidents such as drug driving. Europe reported 7,585 drug-induced deaths but must rely on death certificates which might not reveal drugs’ role.
And that’s not all…
CNN reported that the US opioid crisis is only part of the drug abuse emergency. According to the Center for Disease Control, over 183,000 people died between 1999-2015 from prescription opioid abuse. Adding to that scary number is the National Institute on Alcohol Abuse & Alcoholism which found in 2012 that 5.9% of all global deaths were attributed to alcohol abuse. The UK had 7,327 alcohol-related deaths in 2016. This is eclipsed by an estimated 88,000 people dying in the US annually from alcohol-related causes.
Every person who dies of an overdose or other alcohol or drug related action was somebody’s son or daughter, husband or wife, partner, brother, sister, mother or father, aunt, uncle, grandfather, grandmother, friend, employer, employee, student, etc. For every person that dies suddenly and tragically there are at least 4 people directly affected by the loss. Then there are exponentially more wondering how to deal with this type of death.
Funeral director Kevin Walker stated there is grave emotional stress not only on the families who come in but also stress for funeral directors who have to handle so many funerals of those who overdose, according to ASD, a blog for information about funeral homes and directors. “These families in a lot of cases have been trying to help their children. You’re dealing with grief on another level. You’re dealing with grief where I don’t know if there is ever any consolation for these families.”
Having experienced 5 sudden deaths in my own life time, and worked with people who experience sudden traumatic loss, I know first-hand how challenging and debilitating sudden death can be. When those feelings are compounded by the death of someone who dies from an alcohol or other drugs overdose, feelings become conflicted and complex and healing takes on a new posture. Today, overdoses outnumber deaths from prostate or breast cancer. In fact, an overdose-related death occurs every 14 minutes, which is more than the number of US traffic fatalities each year.
What is different about this grief?
Let’s start by unpacking the experience of grief from alcohol or other drugs including overdoses, car accidents and the like.
- There is little academic research on the subject – death from overdose occurs outside hospital rooms, at home, in friends’ houses, on couches, in bedrooms, in bathtubs, on pavements, in hotels and even in the street. These are not places where research normally takes place.
- There is still a stigma attached to addiction: that the person who died was not strong enough or good enough to stop abusing drugs. Also, unintentional injuries, homicides and other indirectly related incidents can occur from drug use.
- For families and loved ones, the stigma transcends to “I did not do enough” or “I’m a failure for letting this happen”. Shame, prejudice and isolation are common emotions.
- 12-Step groups like Al-anon, Families Anonymous and Coda might feel inadequate.
- Funeral directors are often the ones who must help guide families of overdose that are compounded by stigma (Taunton Daily Gazette, Sept 3, 2017).
What do we know about grief and loss?
People grieve in different ways. No two members of the family will grieve in the same way. Some might rejoice that their loved one is suffering no more while others could be angry or want to climb in a hole and not come out. They feel as if they’ve been branded with a Scarlet Letter that screams “I’m not good enough.”
Like suicide – which I experienced as a young girl when my father took his life – people feel that somehow it could be prevented. “If only I could have done something to stop this from happening.” And so the grief takes hold.
Grief has a number of drivers that fuel its presence. Let’s begin with guilt. Guilt is the feeling that “I did something wrong.” Here are common signs:
- I could have prevented the loss.
- It’s my fault that someone had an addiction, I could have done something.
- There may be a sense of relief that this person does not have to suffer anymore.
- Obsession over actions done or not done to support the person that suddenly dies.
Shame, another driver, comes in the cloak of “I am not good enough”:
- It’s my fault the person had an addiction, my family history says so.
- I did not do enough to help
- It is my fault – I did too much, I always bailed him/her out
- You may feel that you are not worthy enough to be able to mourn.
Blame is a way of dispelling uncomfortable feelings related to the death:
- Feigelman, Jordon, and Gorman in 2011 found a greater incidence of blame between parents who died of drug overdose as well as those who had children die from suicide.
- We might blame the person who used drugs with the loved one.
- We might blame the drug dealers, big pharma, etc.
- Self-blame for the person who developed a substance abuse disorder.
- Self-blame for the person’s death.
- Blame might be thrown at the person who died.
- Blame towards other family members for not taking action or prevention measures.
Stigma and isolation–
- Feeling as if people can see inside your skin and know there is something inherently wrong with you.
- Not wanting to show your face in public. I remember feeling as if everyone knew there was something wrong with me. When I returned baby supplies to CVS following the sudden death of my son Erik, I could feel the eyes of strangers on my back, judging me, as if they knew. Families whose children die from overdoses often feel like they are a piranha and yet they are left to take care of legal issues, cars, apartments, work, insurance, social security numbers, death certificates, etc.
- People often don’t know what to say. This can be seen as disenfranchised grief – as if society says you do not have the right to grieve. One sees this phenomena in many different types of grief. For example, the woman who miscarries a child or has a SIDS death is told she can just have another child. Or the widow who is told she can remarry. Or the father who is told he is not worth your tears. In general, society says that person is not entitled to grieve.
- Fear that the bereaved might do something drastic in their grief, start to abuse drugs, harm themselves, make themselves sick, etc.
- Sleeplessness, lack of focus, absenteeism, etc.
Professionals have a duty of care
With so many families lost in their own private hell when they experience death from overdose, we as behavioural health care professionals – individual clinicians and treatment operators – must start to provide services which help the bereaved.
We must be open and collaborative and join forces with local funeral directors as well. According to a recent National Funeral Directors Leadership Conference, Chief Medical Officer for Beacon Health NY Steven Benton and Phil Phares, whose daughter died of an overdose, said “It’s like we’re surrounded by this lethal epidemic that is right in our own homes, in our backyards, and no one wants to start the conversation”.
As such, we must begin to:
- Realise that the news of someone’s death by overdose could be delivered dispassionately over the phone, in person by law enforcement, or other local authority. Or the family might discover their loved one face down on the floor or in a bedroom or bathroom not breathing and expired. We must realise that this is a traumatic event. The first person someone might deal with are hospitals, coroners offices and funeral directors. Decisions will have to be made as to autopsies, donations of organs in some cases and burial plans.
- Understand that grief is different for everyone. It’s important to face the reality of how someone died and how you choose to honor them. Death is full of euphemisms like “loss” and “passed”. Telling someone that your loved one is dead and that your heart hurts is a great start. In the immediacy of the moment, our defences come into play to protect you from the enormity of the situation as you begin to wrap your head around this loss. A myriad of emotions flood you while having to stay in the present and tackle daily life chores.
- Seek wise counsel. At first law enforcement, hospital personnel, funeral directors, etc could be the first contact. Talk with a grief counsellor, spiritual leader, friends, someone you know who will listen and hear your heart. I often talk about one’s “marble jar people” – these are the people who won’t mind if you call them in the middle of the night, who accept you no matter what. With death, you will learn who those people truly are. Reach out to your marble jar people and don’t be surprised when a few fall off and new ones appear.
- Follow your customs. If it’s a church service, a wake, sitting Shiva, planting prayer flags at the side of a mountain or other celebration, if you have a cultural custom or way of honouring the dead then do that. If money is an issue, Go Fund me or local funeral directors might know of scholarships.
- In the beginning, phone calls, mail and visitors can be overwhelming. Bill collectors, drug dealers, using friends may reach out not knowing what has transpired. Hospital bills, social security cards, automobiles, storage sheds, work even legal entanglements will require attention. Remember: you do not have to answer the phone every time nor handle all mail at once. Take your time. Funeral homes can help with ordering death certificates (I suggest getting 10) and someone knowledgeable in these affairs can help you with necessities including wills and other matters of consequence.
- Understand that life is inextricably tied to death. Grief is normal and not pathological. It is normal to be sad to feel depressed even a bit crazy following the death of a loved one. Grieving Victorians used to wear black armbands for mourning and it is said this was to warn people: Beware – mad person. This imagery can help.
- Understand the nature of substance abuse disorders and remember that you are powerless over these substances. Find someone who will work that step with you. Like 12-Step groups, talking with someone else who has experienced a similar yet ultimately different experience is always helpful. There is an inherent bond with others whose loved one died from an overdose.
- Know that there are good days and bad days. If I think of all the days on which I had a loved one die suddenly and unexpectedly my calendar is full. For example, I remember 23 February, the day my son died of sudden infant death syndrome; every year on that day I think how old he would be; this year, he would be 37. I wonder what he would be like and thank him for being. On 20 April, or every easter my thoughts turn to my first husband and his sudden death. On 7 November, I think of how my father committed suicide from mental health and addiction when I was only 7. I do something to celebrate them on those days, compartmentalising the memories and thank them for the time I had with them. I invite those whose loved ones died of overdose, sudden death to look back, look for goodness and celebrate that they did the best they could as loved ones. Think back on what you did together. Was it go out for ethnic food, play ball together, see a movie? Plan a celebration for your loved one.
- Clothing and other belongings. Different cultures do different things. If you want to keep a small token – something that reminds of you of the person – do so. I suggest you not keep the room the same – it becomes very challenging to move on. If you need help packing or giving away clothes, your marble jar friend is the perfect choice.
- Grief comes in waves like a tidal wave of emotion crashing down on you. Breathe in and breathe out. This will pass and the temporary instability you feel passes too. Your view of the world may become a bit darker and you may feel funny, awkward. Time does have a way of healing.
- So many different things can trigger a grief response. Grief is ruthless – respect its ability to conjure feelings from a birthday to an anniversary, holiday or engagement. If you know it’s coming, plan a small tribute so dread won’t be your bedfellow.
- Know that you are a good person and you are enough. You did the best that you could do. Most of all understand that substance abuse is a disease, and that you neither caused the disease nor could you cure your loved one
- Avoid people who are not helpers. Death sometimes changes the landscape of friendships. Those who you thought you might count on may disappoint you while others come your way.
- Not all support groups are going to be for you. Be sure and check them out. As a person whose loved one experienced a substance abuse disorder, not all memories are pleasant ones. You might have bailed someone out of jail or found them in compromising situations.
- In short, death gives us in an existential way, the opportunity to rise strong, to write a new story, that is transparent, heartfelt, honest and wholehearted.
Resources for family
- Visit Shatter Proof for a strong community of people committed to substance abuse awareness and resources that help you or a loved one going through grief.
- Life After Loss is a one week intensive to help with the grieving process. Milestones Ranch Tennessee
- What’s Your Grief is a website devoted to families
- National Funeral Directors has resources.
Suggestions for friends
- Be Present – Visit or spend time, be available for phone calls, respond promptly to emails of texted, send notes, bring food. In the flurry of activity it’s the weeks that follow that are important.
- Listen – People often rattle on just listen with your heart. Stay neutral, your task is to listen not to bash the person who has died. Anger, tears, disbelief, numbness are common emotions. Your task is to accept your friends feelings not to comment on them.
- Express empathy – People often do not know what to say, being transparent and empathetic requires great courage. Platitudes seem to go out the window. Just be by someone’s side, take them to the grocery store, walk the dog with them, go to the movie, being present is a gift.
- Encourage self care – if your friend is not sleeping or bathing or eating. Grief may cause someone to be lax in selfcare, encourage them to take care.
- Help with practicalities – everything from babysitting, to meal preparation, going for a walk, helping with a household chore, helping with repairs will show support.
Conclusion: for behavioural healthcare providers
Ultimately, love in the midst of a global crisis of addiction means taking care of yourselves. I doubt there are few of us who have not been touched by a sudden death from addiction or mental health in one way or another. To my fellow behavioural health care providers and addiction and mental health specialists, I invite you to think outside the box and create services for families that have had a loved one die of overdose or accident that occurred due to a substance abuse or mental health disorder.
To learn more about Louise Stanger and her interventions and other resources, visit her website.
Originally published at www.recoveryplusjournal.com