The people left behind when someone close to them dies from drug or alcohol use are often forgotten about, especially when it comes to research. Yet the numbers of those affected by these deaths are far from insignificant.
There were well over 8,000 alcohol-related and 4,000 drug-related deaths registered in England and Wales in 2012. And the actual numbers are likely to be far higher than suggested by official statistics because some deaths are not recorded or categorised as being alcohol or drug-related.
Such deaths are frequently featured in the press, especially those of young people and celebrities. But they are often reported in a way that distances the reader rather than inviting sympathy for grieving family members. One bereaved father interviewed for our research on this topic, reflecting on news coverage of his son’s death, said:
I just read ‘Unemployed man dies of drug overdose’ and read down through and it was [my son] and I don’t think the main point about him was that he was unemployed. There was more to [him] than an unemployed man.
Indeed, those left behind are more likely to be pathologised and stigmatised as part of the problem. One bereaved mother who tried to get help with her son’s problem drinking said:
It would seem that they immediately went down the route of what’s going on in the family? …this is a family that aren’t functioning well together.
As such, the bereaved families of drug or alcohol-related deaths remain a hidden and neglected group, with profound consequences for their own health and well-being.
One consequence of this stigma is the frequently poor and insensitive treatment these bereaved people may receive at the hands of the professionals dealing with this kind of death. This can include those working for the NHS, police and legal authorities, funeral services and drug and alcohol treatment and bereavement services.
This was the situation we found during a study by the universities of Bath and Stirling involving lengthy interviews with 106 family members bereaved in this way. Finding such a relatively large sample is perhaps evidence of just how much it has meant to this group of bereaved people to have the chance to tell their stories. Some participants reported being treated with empathy and respect. But more often they met with responses that reinforced the sense that their loss was considered less important than that associated with other types of death.
One bereaved mother talking about the death of her son reported people’s negative reaction thus:
'He was on drugs, what do you expect?’ That was the impression you got. That was the truth of what they were thinking. Whether they were saying ‘so and so’ to me, they are saying to themselves: ‘Another one bites the dust.’
Such treatment is all the more distressing for the bereaved person when they have to negotiate an unfamiliar, complex, confusing and time-consuming process involving a range of separate organisations, often with little or no guidance. Indeed, as we discovered in focus groups with 40 practitioners representing the range of services involved, there is little in the way of any coherent national or local strategy in how organisations respond.
Instead we found that practitioners are also up against the system. Poor responses in part reflect the disparate working practices and cultures between organisations, in which practitioners inevitably lose sight of the bigger picture. The main concern of the front-line services involved in the most immediate aftermath of the death, such as the police, is with the deceased and establishing the cause of death, rather than with the grief of those left behind.
However, we have also been fortunate enough to be able to work with these practitioners to make real inroads into improving the way those bereaved through substance use are treated. A working group of 12 mainly front-line practitioners took on the task of developing a set of best-practice guidelines for those whose work brings them into contact with these bereaved people.
Written by practitioners for practitioners, these guidelines directly engage the reader and invite empathy for the bereaved by explaining their predicament. They are built around five key messages from the interview data, which reflected what the bereaved family members said they needed. These messages are that every practitioner must remember: to show kindness and compassion; that language is important; that every bereaved person is an individual; that everyone can make a contribution; and to work together.
In practice, we hope these principles will encourage practitioners to take actions that will improve the way they work with the bereaved. This can range from simple things like referring to their “son” or “wife” rather than “the deceased”, to carrying out careful planning with the bereaved person of the time they will work with them. We have also provided guidance for practitioners on dealing with specific situations, such as acknowledging a bereaved person’s anger or criticisms towards an organisation and seeking support if the practitioners themselves feel guilty.
By encouraging practitioners to prioritise the human element of their work, the guidelines will promote a culture shift in the way these bereaved people are treated. This can counter rather than reinforce social stigma, reducing their stress and supporting their well being.