Substance-sensitive grief

Substance abuse-related deaths may often be seen as self-inflicted. Many people close to those who have died from substance abuse feel that there is a stigma attached to substance abuse-related deaths. Those close to a person who has suffered a substance abuse-related death say that their primary feelings are shame, anger, relief and guilt. Difficult feelings experienced by loved ones, such as shame and guilt, can lead to social withdrawal and thus slow down or even prevent them from seeking support. People close to the victim may also often feel a sense of failure because they have not been able to prevent the death of a loved one. With the person’s death, the hope of recovery and the possibility of forming a new kind of relationship with them must be set aside. People close to the victim may also feel guilty for having used intoxicants together with the deceased.

Because of the feelings of guilt, shame and stigma experienced by loved ones, professionals should avoid any attitude or bias that could reinforce the loved one’s experience of the death being shameful or stigmatizing.  People close to the deceased are often sensitive to attitudes and biases expressed by those talking with them. If the person feels that there is judgment or blame involved in the encounter, there is a risk that they will start avoiding these encounters altogether, as this will help them avoid being judged or blamed again. The victim’s loved ones should be met in the same way as anyone else who has lost a person close to them – the circumstances may be different, but the fundamental experience of losing a loved one is exactly the same for everyone.

If the deceased has been struggling with a substance addiction for years, their loved ones may have been living in constant stress for years. There may have been major conflicts with the deceased. The same person may have been both extremely dear and extremely difficult. These two experiential dimensions are separate from each other: how dear the person has been, and on the other hand, how difficult the relationship with them has been at any given time. People close to the deceased may feel that the person they knew in the past has, through years of addiction, been gradually lost to substance abuse. Their substance abuse may have made those close to them prepare for the worst – the death of a loved one – for years. Some people may have lost contact with a loved one altogether because of the addiction. Death always comes as a shock to loved ones, even if they have anticipated it. There are also situations where not everyone close to the deceased has been aware of their substance addiction or heavy alcohol consumption. Not all victims of substance abuse-related deaths have a long history of addiction or substance abuse. Substance-sensitive grief also affects many more people than just those whose loved one’s official cause of death is substance abuse. The causes and events leading to death are very diverse, and each person and case must be treated with equal respect.

Those who have experienced the death of a loved one caused by substance abuse go through not only the emotions related to death, but often also the emotional burden that has accumulated over the years of addiction.  When a loved one has a substance abuse problem, the relationship is strained by fear of loss, feelings of anger and disappointment, a clash between hope and despair, and often shame. There is often no space for facing and processing these emotions when a substance abuse problem is present. When a loved one with a substance abuse problem dies, all these feelings may surface, causing confusion and even guilt. Sometimes, the surge of emotion is so powerful and harrowing that it may even provoke self-destructive thoughts.

Depending on the situation, people who have lost a loved one may need a wide range of support after the loss, from dealing with practical matters to talking about it.  The specific nature of a substance abuse-related death should be taken into account when considering the need for support of the victim’s loved ones. Professional support should also be offered to the people close to the victim. Unresolved grief can escalate into depression, which is why it is important that the people close to the victim get the support they need. Due to the special nature of substance-sensitive grief, the need for a bereavement group may be acute immediately after the loss. Talking to others who have experienced a similar loss can be an important form of support for the victim’s loved ones, which is why it is vital to organize bereavement groups for people whose loved one has died due to substance abuse.

Providing information: Understanding why and how someone died is an important part of grief. It is the professional’s task to inform the people close to the deceased about what has happened. Many people think about how their loved one died and what events led to their death. The people close to the deceased want to know who was involved and who was present at the time of the death. They may ask for information from professionals who have knowledge of the events. The professional can also ask them if there is something that they would like to know more about. This information helps those close to the deceased understand what has happened, even if some questions are never answered.

Understanding substance use disorder: When meeting and interacting with the victim’s loved ones, the professional must have an understanding of substance use disorder. The grieving loved ones may also need more information and understanding regarding substance addiction and its effects, so that they can understand what has happened to their loved one. Seeing substance addiction as a disease (like diabetes, for example) can help ease the burden on a loved one and alleviate their feelings of guilt and shame, for example. When treating a substance use disorder, the responsibility lies with the substance abuser, and no one else can bear this responsibility for them. People also die from other untreated disorders and illnesses.

What should professionals pay particular attention to?

It is important for the employee to be able to talk about the grief they encounter at work with a work counselor, either in a joint counseling session with the work community or in individual counseling. Encountering death and bereavement at work may activate feelings of loss and grief experienced by the employee in their own life and outside of work. Grief may be felt in different ways, and it is important to listen to yourself to identify whether your feelings or physical reactions, for example, are related to facing death at work. It is important to relieve the stress experienced at work so that it does not escalate.