Bereavement after a death from drugs or alcohol
Grief after someone died from drug or alcohol use: an overdose, poisoning, liver failure, an accident while intoxicated. It often follows years of fear, crises and hope, and it comes with a death others may judge, as if the person or the family brought it on themselves.
What drives it
Much of the grieving may have begun long before, with every unanswered call and every night in the emergency room, so the death brings shock on top of a grief that started years earlier. Useful for identification because stigma attaches to the bereaved as well as to the person who died, which can silence the grief, keep people from support and leave them alone with guilt about what they did or didn’t do.
How it shows
Work
Telling colleagues it was ‘his heart’ or ‘sudden’ and leaving it there. Years of taking calls from the police or the hospital at work, so that a ringing phone still makes the stomach drop.
Relationships
A relative who says ‘it was only a matter of time’. Family members split over who enabled, who gave up, who could have done more. Being the parent at the support group who doesn’t say what the death was.
Self
Notice whether part of you grieved years ago and part of you is only starting. Notice the scenes you replay: the money given, the door locked, the last call let go to voicemail. Notice whether you feel you have less right to grieve than other people.
What tells it apart
Bereavement after a suicide: Both deaths draw stigma and the question of why, and Feigelman found parents’ grief similar after each. Suicide bereavement more likely centers on the person’s intent, and drug death bereavement on years of living with the use and an unclear line between accident and choice.
Ambiguous loss (Boss): Before the death, a person present in body and lost to addiction is a form of ambiguous loss, and that may be where much of the grief began. After the death the loss is clear, and the grief may hold both.
Bereavement guilt and regret (Li and Stroebe): Bereavement guilt covers regret after any death. After a drug death it more likely fixes on specific acts, the money given or the door locked, and hindsight may make the outcome look more certain than it could have looked at the time.
A test
Ask how long the person was afraid of this death before it came, and who they have told the cause to. A long ‘before’ and a cause kept to oneself may point to a grief shaped by the substance use as much as by the death.
Questions to carry
- When people ask how they died, what do I say?
- Where do I tell myself I have less right to grieve?
Go deeper
- Read: The Other Side of Sadness, George A. Bonanno, 2009, revised 2019. Written for readers by a psychologist who has followed bereaved people for years. He questions the idea that grief moves through set stages and argues that most people come through a loss with more resilience than expected. Much of it rests on his own group's studies.
How strong the research is
moderate. In the largest interview study of its kind (Templeton and colleagues, Addiction Research and Theory, 2016), 106 adults in England and Scotland bereaved through a relative’s or friend’s drug or alcohol use described years of living with the substance use, including grieving before the death, a death that was often traumatic and stigmatized, and responses from professionals and others that were more often negative than positive. Valentine, Bauld and Walter (Omega, 2016) reviewed the research and called this a disenfranchised grief largely missing from bereavement research and services. In 32 adults from the same study bereaved by an overdose (Templeton, Valentine, McKell and colleagues, Drugs: Education, Prevention and Policy), many described guilt, self-blame and a sense they did not deserve to grieve. In a US survey of 571 bereaved parents, most of them from support groups (Feigelman, Jordan and Gorman, Omega, 2011), the 48 whose child died from drugs reported grief, mental health problems and stigma at about the level of parents bereaved by suicide, and more than parents bereaved by accident or natural causes. In 255 people bereaved by a drug death in Norway’s END project (Death Studies, 2022), 67% said they had withdrawn from others to some or a high degree. The samples are small and self-selected, and the comparison with other causes of death rests on one survey with a small drug-death group.
Where it comes from
Christine Valentine, Linda Bauld and Tony Walter, from the study Understanding and Responding to Those Bereaved Through their Family Member’s Drug or Alcohol Misuse, Universities of Bath and Stirling, funded by the Economic and Social Research Council, 2012 to 2015. Kenneth Doka (editor), Disenfranchised Grief, 1989. William Feigelman and colleagues, 2011