Author – Luisa Kcomt, Ph.D., L.M.S.W.
Overdose bereavement is an underrecognized aspect of the drug epidemic in the U.S. It refers to the experience of loss resulting from a drug overdose death. Experiencing the death of a family member from drug overdose is unlike grieving a death from natural causes—in large part, due to the context of relationships prior to the death, the nature of the death itself, and the stigma surrounding addiction and overdose deaths.
Addiction produces negative cascading effects on individuals and their families. A great deal of loss and trauma often occur prior to the overdose death. Because addiction compromises daily functioning, it can create financial, employment, and housing instability. Social relationships often become impaired and family separation or dissolution is common. Children’s lives can become disrupted. Living in a household with drug or alcohol misuse is considered an adverse childhood experience, which places children at higher risk for academic problems, chronic health problems, suicide, and mental health and substance use disorders. The child welfare system may be involved to secure a safe placement for the children. When an overdose death occurs, it is akin to a “double death”—that is, the pre-death loss of the person to addiction and loss from the actual death.1
Stigma
Stigma is defined as “an attribute that that is deeply discrediting,” reducing an individual from being a “whole and usual person to a tainted, discounted one.”2 Stigma is a complex social phenomenon that consists of four components converging together to create and reproduce social inequalities:
- Labeling—where human differences are identified and labels are affixed, but the validity of these designations are questionable
- Stereotyping—in which the human differences are associated with negative attributes and are devalued
- Exclusion—where labelled individuals are set apart and dehumanized
- Status loss and discrimination—whereby individuals are relegated to a lower rung in a status hierarchy, lending itself to individual and structural discrimination
The negative stereotypes can be so pervasive within a specific culture that it can become part of the socialization process within that culture. Expectations are formed about whether the labelled individuals will be rejected or devalued, and individuals who are faced with the possibility of having the label applied to them will begin to fear and expect rejection and devaluation.3
The stigma surrounding addiction and the overdose death can influence and complicate the grieving process for bereaved family members. Negative stereotypes exist about individuals with substance use disorder and those engaging in substance misuse; they are perceived and treated as deviant or morally reprehensible. Family members often feel shame and guilt for not being able to help their loved one to overcome their addiction. This stigma extends beyond the overdose death, which is considered a bad death because of its perceived self-inflicted nature. The stigma surrounding addiction and drug overdose deaths isolates the deceased and their bereaved from their communities and from potential sources of support.4
Many overdose bereaved individuals receive negative comments from their family and friends, work colleagues, neighbors, acquaintances, professionals, and the media/social media. The types of negative comments include:
- Dehumanizing labeling—disrespectful words or expressions used to describe the deceased person, their way of life, or their characteristics (e.g., “junkie,” “drug addict,” “criminal,” “selfish,” “weak”). Such words are hurtful and derogatory.
- Unspoken or implicit stigma that is often communicated indirectly, such as the silence or lack of support that overdose bereaved individuals receive from their social network after the death.
- Blaming the deceased for their substance use disorder and their overdose death.
- Statements implying that death was the only and best outcome for the decedent and for the bereaved (e.g., “He was never going to be drug-free. Now that he’s gone, you don’t have to worry about his problems anymore”). These comments suggest that there was no hope of recovery from addiction, and that the death spared the decedent from pain and the bereaved from the burden of having to care for their loved one.5
Overdose Bereavement
Given the stigma surrounding addiction and overdose deaths, many bereaved family members fear judgement from others and thus, may conceal the nature of the death. They may experience disenfranchised grief, wherein the death is not acknowledged, socially validated, nor publicly mourned. Overdose bereaved individuals have reported feelings of frustration, sadness, and loneliness at the lack of social support and understanding from others about the addiction and overdose death. This stigma denies them the opportunity to share their story and to openly mourn their loss. It reinforces their invisibility and marginalization.1
Bereaved family and friends may also feel conflicted about their grief emotions. They may have internalized the stigma of substance misuse and addiction and thus, feel shame, guilt, and self-blame for not doing more to prevent the death. They may feel anger towards their loved one because they perceive the overdose death as self-inflicted. They may feel relief because they had been living under a great amount of stress prior to the death. Yet, relief is not considered to be within the social norms related to grief.5 The sudden nature of the death precludes the opportunity for the bereaved to say goodbye. If the substance misuse behavior was unknown to the bereaved, then they are left with unanswered questions.
Professionals who hold a negative bias towards individuals with substance use disorder may be complicit in creating structural barriers to care. Overdose bereaved individuals will be reluctant to seek care if they detect a negative bias from their provider. Despite the rising number of overdose deaths, little attention has been paid to those bereaved following substance misuse. The opportunity to receive formal support is very limited. Thus, professionals should assess their own attitudes about substance misuse and overdose deaths, and to mitigate the barriers for overdose bereaved individuals to receive support. Learn more about Supporting Those Grieving an Overdose Loss.
References
1. Valentine C, Bauld L, Walter T. Bereavement following substance misuse: A disenfranchised grief. Omega (Westport). 2016;72(4):283–301.
2. Goffman E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, N.J.: Prentice-Hall; 1963.
3. Link BG, Phelan JC. Conceptualizing Stigma. Annual Review of Sociology. 2001 Aug;27(1):363–85.
4. Dyregrov K, Møgster B, Løseth HM, Lorås L, Titlestad KB. The special grief following drug related deaths. Addict Res Theory. 2020;28(5):415–24.
5. Dyregrov K, Selseng LB. “Nothing to mourn, he was just a drug addict” – stigma towards people bereaved by drug-related death. Addict Res Theory. 2022;30(1):5–15.