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If you thought the avoidance around death and grief in our society was bad, it is nothing compared to the avoidance of drug-related deaths. Don’t believe me? Did you know that overdose deaths outnumber traffic fatalities in the US? Did you know that someone dies every 14 minutes from a drug overdose in this country? In 2011 data came out showing that prescription medication overdose deaths outnumbered heroin and cocaine deaths combined. Overdose deaths outnumbered prostate cancer deaths and are nearing the number of breast cancer deaths. Don’t feel bad if you didn’t know – that’s the point. We hate talking about it!
Even as we see celebrity overdose deaths, from Anna Nicole Smith to Michael Jackson to Cory Monteith to countless others, we don’t like to face the terrifying reality that addiction can touch anyone, anywhere. We don’t want to consider that even with more money for treatment than most of us could ever imagine, people still loose this battle every day. And even when we hear the statistics, we don’t want to think about the fact that there are real people behind those statistics – real lives lost and real people grieving.
As more and more people are touched by addiction, more and more families are left with the grief of an overdose death. Yet the unique experience of grieving an overdose death is still pushed under the rug. It hides out in the shadows. It is veiled in guilt and shame and stigma and discomfort. And this isn’t just a social avoidance, academic research hasn’t even faced this topic. A 2011 article by Feigelman, Jordan and Gorman highlighted the astonishing lack of research in this area. They noted that despite the significant impact of overdose deaths, “an exhaustive search for entries on grief or bereavement and overdose (or drug) deaths from Med-line, Psych-Info, and the Social Science Index yielded only two research notes on the topic. Both studies were done outside the United States: one a Brazilian study (da Silva, Noto, & Formigoni, 2007), and the other a British study (Guy, 2004).” Say what?! Two?? That’s it?? Are you kidding?!
Okay, sorry. I get a little fired up about this issue. This year a close friend from high school died of an overdose. My family has been touched by addiction from many directions and eight years ago my sister’s boyfriend, who was more like family, died of an overdose. I can think of far too many other friends and acquaintances who have died from drug overdose over the last 10 years. Results: I get excited that International Overdose Awareness Day exists and I get infuriated that there is so little discussion about the unique experience of those grieving overdose deaths.
So guess what? Today we are talking about overdose grief –partially inspired by International Overdose Awareness Day, partially inspired by the research of Feigelman, Jordan, and Gorman, partially inspired by my own experience, and partially seeking comments from all of you who have experienced overdose deaths and found ways to cope. Let’s talk unique challenges of drug-related deaths.
The Death Feels Avoidable
Much like suicide grief, there is a complexity in overdose deaths in that people feel like the death was somehow preventable. This can created an array of complicated emotions, many of which can be linked back to this feeling or belief. Many of the feelings below, including guilt, shame, blame, fear, and isolation all in some way can be correlated back to this.
Though guilt can be a component of grief from many types of losses, overdose deaths can present many different types of guilt.
- Friends and family may feel guilt that they could have, or should have, done something to prevent the loss.
- Guilt that the family member suffered from addiction (i.e. a parent, spouse, etc feeling it is their fault the person who died developed an addiction)
- Guilt if the death brings a sense of relief after years of addiction impacting family and friends.
- Obsession over actions done/not done to support the person who died.
There is often a question of the difference between guilt and shame, but it is important to understand the distinction as these can impact someone grieving an overdose death. There are many different ways you will see guilt and shame defined and contrasted against each other. Here we mean this distinction as a contrast between a personal experience vs a relational experience. Guilt is something we feel within ourselves, based on our own perception that we could or should have done in a certain situation. Shame is something we feel based on our perception that others think we could or should have done something differently. In the case of overdose death, shame can manifest in various ways.
- Shame that the family member suffered from addiction (i.e. a parent believing others think it was their fault or they were a bad parent for having a child who suffers from addiction)
- Shame for enabling the person who died.
- Shame for not doing enough to “help” the person who died.
- Shame for the person who died (feeling that others blame that person for their addiction and/or death, and hence are less worthy of mourning)
Please keep in mind that there is another definition/distinction you will often hear between guilt and shame – one that is actually common in substance abuse and recovery. In this definition people say that guilt is the idea that one did something bad, whereas shame is the belief that one is bad. So, guilt is a feeling about an action and shame is a feeling about the self. Clear as mud?
Though that is a very important distinction to make, it is not the way we are talking about shame here. My experience with the word shame, and with the grief experience that accompanies it, is shame in the relational sense – shame that others are judging us or our loved one.
Though there is little research around the grief experience of survivors of overdose deaths, the study by Feigelman, Jordan and Gorman (2011) found a greater incidence of blame among and between parents of children who died of drug related deaths (as well as those who had children die by suicide). This is both self-blame, as well as blame between friends and family members. Though this is the first US research to officially document this, it seems pretty darn intuitive if you have lost anyone to overdose or known people who have. Some common feelings that arise around blame are:
- Blame toward those who used drugs/alcohol with the person who died.
- Self-blame for the person developing an addiction.
- Self-blame for the person’s death.
- Blame toward the person who died for their own death.
- Blame toward family members for not preventing the death.
- Obsession over actions done/not done to support the person who died.
In the Feigelman et al (2011) study, a tally of blame comments made to parents showed that 97%+ of blame comments were made in cases of suicide and overdose deaths, in contrast to 2-3% in cases of accidental deaths and 0% in cases of natural deaths. 64% of these comments were blame toward the child who died, with the remaining 36% of the comments blaming the parent. Nearly 50% of parents who lost a child to overdose or suicide reported blame comments being made by one or more of their significant others. It is easier and easier to understand why people don’t speak up about addiction and overdose deaths, isn’t it?!
Stigma and Isolation
Though we know addiction touches hundreds of thousands of families each year, the family and friends of those experiencing addiction often suffer in silence due to the feelings of stigma, guilt and shame. When someone dies from overdose this isolation often continues from reluctance to talk about the addiction. This can result in:
- Difficulty accepting the circumstances of the death (denial about drug involvement).
- Reluctance to openly discuss the cause of death.
- Reluctance to participate in support groups or counseling.
- Hesitance to seek support from friends and family members.
In the same Feigelman et al (2011) study, 50% of parents who lost a child to suicide or overdose deaths did not find the support that they expected from their significant others, contributing to feelings of isolation. People say stupid things to us all the time as grievers. Overdose deaths can bring out some of those especially terrible comments that drive us further into isolation. People make us feel this death is not as worthy of grief and mourning as other deaths, which throws it in the complicated category of disenfranchised grief.
Fear and Anxiety
Addiction is a devastating disease that is difficult to imagine if you have not experienced it within your family, friends, or community. I struggle writing this to even put it into words. It turns family members into strangers. It pins friends and family against one another. It devastates communities. Once someone has lost a family member to addiction anxieties can arise (or increase) and become consuming:
- Fear that other family members will start abusing substances.
- Fear that others who are already using substances will also overdose.
- Fear that others who are in recovery will relapse.
All of these anxieties can lead to mistrust between surviving family members and friends. This anxiety can lead survivors to attempt to control those around them, trying to protect them from addiction and overdose. These anxieties and attempts at control can become consuming if not addressed.
All of this sounding familiar? Wondering what you can do to manage this devastating type of grief? Check our Part 2 of this post here, where talk about some tools and resources for coping with the grief of an overdose death. Don’t forget to check out the International Overdose Awareness Day website.
Head over to our store and check out our print resource: Surviving the Grief of an Overdose Death
If you read the post and were one of those people screaming, “That is me and my family!!! What do I do???” have no fear –this is our follow up on some thoughts on integrating the grief of an overdose death. First, let me remind you again: you are not alone, even if it feels like it. This has been me and my family. This has been thousands of other families. One family every 14 minutes begins the process of enduring the terrible pain of an overdose death. There is all the usual pain of grieving, and then there is the guilt, shame, blame, isolation, fear, and other unique and challenging emotions that come with this grief. All of these will need to be faced and addressed in some way and it takes time. It isn’t easy. There is no one answer or one way to grieve an overdose death, so you will need to find what works for you. I can give you suggestions and thoughts from my personal and professional experience, but I encourage you to share your own experience. It is going to be a little different for us all, so the more suggestions and reflections the better!
Face the reality of the circumstances of the death.
Denying the role of substances in our loved ones’ deaths is not surprising, when can be so much stigma and blame. Finding your own way to face the role of drugs in the loss, either to yourself and/or to others, is an important part of grieving an overdose lost. Facing this reality is part of task #1 of Worden’s Tasks of Grief, phase #1 for Rando’s Processes of Mourning, and stage #1 of Kubler-Ross’s stages. We often deny to ourselves and/or to other people the role of drug on the death because it feels easier that way. In the long term we need to be honest with ourselves about circumstances of the loss in order to address any complicated feelings around those circumstances.
If you need a push, commit to accepting the circumstances of the death in honor of International Overdose Awareness Day on August 31st. Decide what is right for you, but one possibility is to leave a tribute to the person you have lost to an overdose on the International Overdose Awareness Day website. There are hundreds of thousands of incredible people whose lives have been lost to overdose. Their addiction and their overdose do not change the fact that they were people we loved, people we remember, and people we grieve. Share who they were and how they died; each voice begins to change the stigma, blame, isolation, and shame; each voice remembers someone loved and deeply missed. The simple act of posting a tribute on the site is an acknowledgement of the circumstances of the loss and a step toward accepting the reality of the nature of the loss. This is one of many small things you can do to begin the process of accepting and acknowledging the death as an overdose death.
This doesn’t have to be verbally, but find some way that you will express the emotions that come with addiction and drug-related death. Do you need to yell from the rooftops? No. You may not even be ready to talk about it at all. Maybe you will find writing, art, music or photography are a better form of expression for you. Maybe you will blog about it! But one way or the other, start working toward a place where you can express your feelings about the addiction and overdose. If you are looking for simple, subtle expression you can purchase a silver overdose awareness pin or simply wear something silver on the 31st.
Though finding a means of expression is about you, keep in mind that it will also help others. It is our collective silence that keeps us in this vicious cycle of feeling alone and maintaining stigma. I remember the first time someone told me they had someone in their family suffering from a heroin addiction. It was a co-worker at a job I had many years ago. She said it in passing, like she had no reason to be ashamed. Up until that moment I thought everyone kept addiction in their family a secret. More accurately, I actually just assumed that no one else I knew was experiencing addiction in their family! I remember telling her my own story and feeling an indescribable sense of relief to know that I was not alone and my family was not alone. I decided from that moment on that I would stop hiding and lying about addiction, because if I could bring one other person that same sense of relief and connection it was worth the shame and judgement I feared. Will this kind of open discussion be right for everyone? No way. But it works for me and I am overwhelmed with the number of people I learn have been touched by addiction and overdose just by being open and honest about it.
Most of us will always have some feelings of guilt and self-blame for the overdose deaths, and that is okay. Really. (if you want to know more about our thoughts on guilt, you can check out our post on guilt, grief, and why you shouldn’t tell a griever not to feel guilty here). The difference in my feelings now from many years ago around overdose is that I have a far better understanding of addiction. In the spirit of nar-anon, al-anon, and Melody Beattie I have accepted that I am powerless over someone else’s addiction. Though I shudder at every celebrity overdose death, it reminds me that all the money and love in the world still cannot always beat addiction. Does that belief dissolve all my guilt? Nope. Does it get rid of all the “what ifs”? Absolutely not. Does it change the fact that I believe that love and quality treatment can be life changing for someone suffering from addiction? No way. Grief and guilt are not rational, so we cannot reason them away. But this deeper understanding of addiction does help to keep my guilt in a normal, manageable, range rather than spiraling, obsessing, or becoming consumed by anxiety. It has helped me realize that much blame around addiction and overdose is misplaced. It has helped me feel empowered when I talk to others and address the myths and misconceptions about addiction and overdose.
Stand-up For Yourself
As Feigleman et al (2011) suggest, “openly challeng[ing] unhelpful but well-intentioned efforts among intimate associates may help these survivors to establish more supportive environments for their healing among their families and friends”. We have this tendency to shy away from telling people when their well-intentioned comments are not helpful. We let the comments slide, though we may ruminate about them later. If you are not feeling supported by the comments of friends and family, tell them! They may not realize that their well-intentioned words or actions are not helpful.
Avoid People Who Aren’t Helping
Some friends and family members will continue to be part of the problem, even after you talk to them about it. They may imply an overdose death is some sort of lesser death, or that the life of someone suffering addiction is somehow less worthy of mourning. If you give them feedback, stand-up for yourself, ask them for the kinds of support you need and they continue to cause your more harm that support, avoid them. Seriously. It is okay to give yourself permission to get some space from those people. Depending on your relationship with that person you may want or need to reintroduce them into your life in the future, but for now you need to focus on being surrounded by people who are supporting you in your grief. Want some help sorting out your support system and identifying who might help you the most? Check out our support system superlative journal prompt.
Learn About Specific Resources
Though it may feel like you are all alone, there are resources specifically for people grieving substance deaths:
GRASP (Grief Recovery After Substance Passing) has groups that meet around the country and is specifically for those grieving an overdose death.
Broken No More has forums, articles, and resources for those grieving substance abuse deaths, and also works to change the stigma around addiction.
Mom’s Tell provides information regarding substance abuse treatment, recovery, education, prevention legislation and policy issues in memory of the many lives lost to substance abuse. It was founded by group of mom’s who lost children to overdose and has been active for 15 years.
Al-anon and Nar-anon are family support groups for family members of those suffering from alcoholism or addiction. Though they are not grief groups, many people find support in these groups following drug and alcohol deaths. Though each group that meets will be different, my experience with these groups is that they are very open and supportive of those who lost someone to overdose.
Local Support Groups a google search in your area or calls around to some hospices may help you locate drug-related death support groups in your area, if there is no GRASP meeting in your area. More and more of these groups are popping up around the country, as overdose deaths continue to increase. If you know of one of these groups in any area across the county, please leave it in a comment to help others locate a group.
Relief After A Death: the unspoken grief emotion
Whenever we ask people about the emotions of grief, whether it is here on the blog, in a workshop, a group, or a class, the word relief inevitably comes up. We’ve listed it off a time or two on WYG when discussing common responses to loss, but we’ll admit we’ve only touched on it in passing. It really wasn’t until the other day, after we received a handful of comments about relief following our recent post about suicide grief, that I realized the experience of relief after a death warrants its own discussion. It would seem we’ve been remiss for not discussing it sooner.
I’m going to pull a serious 8th grade book report move here and start the conversation by defining relief. According to the Oxford English Dictionary there are two definitions:
- The act of removing or reducing pain, anxiety, etc.
- The feeling of happiness that you have when something unpleasant stops or does not happen.
So, I’m not sure I would go so far as to use the adjective “happiness”, but based on this definition feeling relief after a death, in certain circumstances, does kind of make sense. Death often comes after a period of intense and prolonged pain, anxiety, worry, fear, and suffering. Although none of you wanted your loved one die, it’s only human to feel relief when their pain and suffering comes to an end. It’s also human to feel a tinge of relief when the distress you felt as a result of having to watch your loved one struggle has come to an end.
As logical and as common as the emotion of relief is in grief, it seems like grievers often carry it with them as thought it’s a deep, dark secret. For many, relief feels like something they should be ashamed of, it feels wrong, or as though it’s something they shouldn’t admit to. This may be the case for a whole slew of reasons, many of which stem back to an interesting assumption about how emotions work. Well, two assumptions really.
Assumption # 1: People often think they experience emotions one-at-a-time. Typically in any given moment if I were to ask you how you felt, you’d probably identify the most prevalent feeling – i.e. “I am scared”, “I am happy”, or “I am overwhelmed”. However in many situations, you can (and often do) feel multiple emotions at the same time. You may even feel emotions that seem inconsistent with one another. Ever heard of the phrase “mixed emotions”?
Assumption #2: People often assume that feeling one emotion somehow detracts from or negates another. So you may think to yourself – “If I am feeling relief, then I can’t possibly be as sad as I should be.” When in reality you can be super sad and also a little relieved at the same time because emotions aren’t mutually exclusive. You can have two emotions about two totally different aspects of an experience. You can feel relief that distressing emotions and physical pain have ended, but this relief does not lessen the devastation and intense sadness caused by the death of a person who you love very dearly.
So while we’re busting assumptions and misconceptions, let’s discuss a few common experiences related to relief.
1. The person was physically ill and suffering. Caring for the person was mentally and physically exhausting and it was terrifying to watch the person lose their physical and/or cognitive faculties.
Myth: Feeling relief in this situation means you wanted the person to die.
Fact: Feeling relief in this situations means you are glad their suffering (and/or your suffering as a caretaker) has ended. You did not want them to leave you, you would give anything for them to have been cured and to have lived pain free. However, given the existence of ongoing pain, you wanted their suffering to end.
2. The person was suffering from addiction. Addiction doesn’t just impact the person struggling with it, but the whole family. It can create emotional, financial and legal issues for families. It can keep families in a state of constant anxiety, guilt, shame and hyper-vigilance, always fearing an arrest, overdose or death. It can be a relief when these experiences end.
Myth: Feeling relief in this situation means you wanted the person you love to die.
Fact: What you wanted was for your loved one’s addiction to end so their suffering could be over and so that they could be the person they were before their addiction. Your hope was for recovery, not death. You relief is not because you wanted them to die, but because the toll of the addiction itself has been lifted.
3. The person was battling mental illness. As many commenters mentioned on our recent suicide post, the strain of mental illness and the fear of a suicide death can be overwhelming for family members. Like addiction, there can be a continuous sense of helplessness, loss of control, and anxiety. The person’s death is devastating, but the relief from those constant feelings and experiences is undeniable.
Myth: Feeling relief in this situation means you wanted the person to die.
Fact: Much like with addiction, all you wanted was for your loved one to find manageable treatment for their mental illness so their suffering could end. Your hope was for stability, not death. You do not feel relief because you wanted them to die, but because the anxiety and constant fear has been removed.
4. The person was an abusive person or you and the person were in a problematic/unhealthy relationship. These relationships are often marital or parent/child relationships, but can be true of any type of relationship where a person feels constantly trapped and controlled by another person.
Myth: Your relief mean you hated the person and wanted them to die.
Reality: You wanted to escape the relationship. In many cases, an outside observer may think you could have ended the relationship at any time, but you may have felt it was not possible for a number of reasons. When the person dies, the death can cause relief because the painful and problematic relationship has ended, even though you may have wished it would have ended in another way.
This does get a little tricky when trauma or abuse is so severe that you may truly be glad they died because it brings a sense of justice, or because no matter what you would have felt fear and anxiety knowing the person was still in the world. Such experiences, thoughts, and emotions can be extremely complex, so if you are struggling with guilt in these situations you may want to think about talking to a counselor.
If you have been struggling with guilt around feeling relief after a death, you are most certainly not alone. There is no magic way to resolve your guilt, but what we hope you will remember from today’s post, if nothing else, is that relief is extremely common and incredibly normal in grief. Feeling relief about certain aspects of your loss in no way diminishes or minimizes your love for the person or your grief from that loss.