Grief and a death due to substance use

“There were years of dealing with the stigma and fighting for my brother, and hoping and then having my hopes dashed, over and over. By the time he died, there were layers of grief under that loss.”

Why your grief may be different

Grief stemming from a substance-related death can be particularly complex for the people left behind. Some reasons for this may include:

• Learning new details about the person’s life, lifestyle, or substance use after their death, may impact your perception of who you thought they were. 
• Although this is not the case for everyone, you may have been  experiencing ongoing and complex grief prior to their death due to their substance use and addiction challenges.
• You may have questions about the circumstances of the death, especially if substance use was not a regular part of the person’s life and/or the supply was lethal
• At the time of the death, you may have been hopeful that the person would access treatment, and/or you may have been estranged and disengaged. 

Complex thoughts and feelings

The thoughts and feelings that surface following a substance-related death may be extra complicated and can include the following:

• Anger or frustration
• Regret, remorse, or guilt
• Shame
• Relief/not having to worry any more
• Resentment
• Worry, angst, or fear
• Deep longing for things to have gone differently

Some of these feelings and thoughts may take a significant time to work through, to release or to soften. 

Stigma and isolation

Although anyone, at any age, and from any walk of life can die from substance use, societal and cultural attitudes and beliefs may influence how people respond to your loss and grief. As you grieve you may encounter the following:

• Judgments from other people, such as shame and blame, about the person who died and their substance use
• A lack of or a withdrawal of support or hurtful comments from people you thought would support you in your grief 
• Feelings of anger and resentment toward people who didn’t help before the person died
• A desire for your person to be known for all parts of who they were, not just any substance use they engaged in or how they died

Sense of injustice 

You may be struggling with your thoughts and feelings about the senselessness of the person’s death. You may also struggle with ideas about who is to blame and whether the death was preventable, for example:

• Inadequate support and resources for mental health, homelessness, substance use, and addiction
• Seeing the person who supplied the substance as responsible for the death and wanting them to be accountable
• Blaming a healthcare provider if the person who died became substance-dependent after being prescribed pain medication 
• Anger and frustration with the ongoing systemic issues and drug policy within our communities related to criminalization, stigma, and unsafe supply

Trauma

You may experience a variety of aspects of this loss and death as traumatic, for example:

• The long-term impact of the hardships you witnessed in the person’s life, such as illness, injuries, poverty and abuse 
• Distressing flashbacks, nightmares, images, or intrusive thoughts of the person’s death or the circumstances around it
• The tragedy of a person - often a young person - dying before their time or before they’ve had the opportunity to live a long life

See also:

• MyGrief.ca Module 25 - Grief after trauma

When your grief is not recognized by others

The situation may have led you to be private about your loss. People in your life may not understand the impacts this loss is having on your life. Your grief may feel heavier and more confusing if you do not feel it is recognized and acknowledged by others. This is sometimes called disenfranchised or unrecognized grief.

See also:

• MyGrief.ca Module 27 - Unrecognized grief

• Try to acknowledge and honour your own thoughts and feelings and the impact of this loss. This is an important first step in finding ways to understand and live with loss.
• You may find it helpful to share your thoughts and feelings with supportive people. Look to family and friends who are able to listen without passing judgment or giving unwanted advice. 
• Being with others who have experienced something similar may be helpful. Consider a bereavement support group (either in person or online) for people who are grieving a substance-related death. 
• It may help to remind yourself that we have little or no control over others’ lives, and to recognize that there may be things you know now that you didn’t know or couldn’t have known before they died.
• You may find it helpful to participate in advocacy and/or public awareness activities related to substance use, mental health, the need for better supports, and/or drug policy.
• Grieving can be hard and exhausting. Practice “picking up” your thoughts and feelings and “putting them down” as you are able. 
• You may find it helpful to connect with a healthcare provider or a professional grief counsellor.

• Most importantly, acknowledge the death, their relationship, and their grief.  
• Invite conversation about the whole life of the person who died; their personality, accomplishments, story and not focus only on their death. Say their name.
• Be willing to be present with them and witness their pain without trying to fix it or make it go away. 
• Do not say anything that may be judgmental. 
• Take your cues from them, and provide emotional support by spending time and listening with compassion, patience, and non-judgment.
• Language matters: Use respectful, non-blaming language such as “toxic drug poisoning” rather than “overdose”, and “someone with substance use disorder” rather than “addict”.
• Ask and listen carefully about how you can be most helpful. 
• If you can provide practical support, offer and get permission to do something specific (e.g., yardwork, grocery shopping, pet care, driving, meals).
• Consider joining with them in their advocacy and justice efforts. 
• Be there for the long run

See also:

• Supporting someone who is grieving

If you feel overwhelmed or “stuck” please talk to a health professional or trusted leader in your community such as a doctor, chaplain, nurse practitioner, social worker or school administrator. These trusted people may be able to connect you with appropriate programs, resources, and other forms of needed support such as grief counselling or medical care. You may be able to access counselling services if you have an Extended Health Plan, or through an employee assistance program. It will be important that they have experience in grief counselling. If you have thoughts of or plans to harm yourself or others, go to your nearest Emergency Department, call your local Crisis Line, or call or text 9-8-8 if you are in Canada. It is essential that you reach out for help.

See also:

• Do I need more help?
• MyGrief.ca Module 8 - Do I need more help and where to find it

When someone you know has died as a result of substance use, your grief may include thoughts, feelings, and experiences that are different from those you’ve had in the past. You may feel isolated in your grief because others avoid talking about what has happened, or because you are reluctant to share your experience. Acknowledge your grief, find people you can share it with, and access professional help when needed. 

See also:

• MyGrief.ca Module 24 - When someone has died related to substance use