How Do Drug-Death-Bereaved Parents Adjust to Life Without the Deceased? A Qualitative Study

Letter Writing as a Clinical Tool in Grief Psychotherapy

The benefits of expressive writing have been explored since at least the 1980s. The effect of expressive bereavement-related writing has been studied primarily in college students, yielding inconclusive results. Nonetheless, recent effective, integrated psychotherapy protocols, targeting complicated and prolonged grief, include writing assignments, typically in the form of letters. The present paper explores how and why letter writing might be effective and meaningful as a therapeutic tool in the context of grief psychotherapy. It describes how working with letters, addressed to the deceased, might help facilitate self-disclosure, promote exposure to what is avoided, confront unfinished business, encourage continuing bonds, and help achieve a coherent narrative around experiences with the loss. As a therapeutic tool, letter writing has the potential to be helpful to many bereaved people, as it is a simple, effective, and meaningful way to access and work with relevant clinical material in the context of psychotherapy.

Drug-Death Related Bereavement and Social Support

The loss of a close one to drug-related death (DRD) has been characterized as a form of stigmatized bereavement, and research has shown that there is a high risk of bereavement complications. Social support can be a buffer against bereavement complications, but because of stigma, DRD bereaved persons access to social support can be challenged. Based on data from a Norwegian sample of DRD bereaved persons (N = 252) the present study examines (1) bereaved persons' perceived access to different aspects of social support, and (2) the association between bereaved persons' experiences of societal stigma, own withdrawal, self-blame, and their perceptions of social support. Results show (1) that bereaved persons' access to contact with persons in the same situation is particularly low compared to other support aspects, and (2) that perceived stigma (4%) and own withdrawal (5%) predict variations in drug-related death bereaved persons' perception of social support.

The experience of drug-related client loss for healthcare professionals who support people in addiction

INTRODUCTION

Addiction support and recovery is a multi-faceted support context in which practitioners work with clients who present with increased mortality risks. Drug-related deaths are understood to be a risk factor for complicated grief-reactions but, to date, research has neglected to explore the intricacies of drug-related client loss for practitioners who work with clients experiencing addiction. Due to wider expectations of professional endurance and the demanding nature of health care, grief-related reactions associated with the loss of a client may go unprocessed and, therefore, result in long-term health implications.

METHOD

Fifteen health care professionals took part in individual semi-structured interviews, which were analyzed using reflexive thematic analysis. Participants represented various disciplines in addiction support and recovery, including homelessness, inclusion health, addiction, and emergency medicine.

RESULTS

Three core themes emerged encapsulating the experience of drug-related bereavement for HCPs who support people experiencing addiction, as follows: (i) Grief Beneath the Surface, (ii) The Cost of Caring, and (iii) Finding Closure. The findings identified acute grief-related reactions in HCPs such as self-blame and shame, alongside fears of litigation and questions of clinical competency. Participants' accounts of drug-related client loss emphasized a deep professional connection with those that they work with, with grief-responses akin to the loss of peers, family members, and other close connections. The bereavement experience was complicated by unique compounding variables associated with drug-related deaths, but also by incongruity between their emotional responses to death and their professional responsibilities.

CONCLUSIONS

This article highlights the complex nature of drug-related client loss, and despite their social positioning as experts in their field, HCPs' reactions to client deaths were predominantly human responses to loss. The article identified a need for targeted postvention protocols that address complicated grief while also allowing staff to resume occupational functioning in a measured manner.

To lose a friend: the relationship between professional help and grief among close bereaved friends after the terror attack, 22 July 2011

Background: Close friends are often an overlooked group of bereaved people. This study is based on a sub-project on young adults who experienced the loss of a close friend in the terrorist attack on Utøya, Norway, on 22 July 2011.Objective: The aim of this longitudinal study was to explore the relationship between complicated grief reactions, the need for help, and help received after losing a close friend to a traumatic death.Method: In total, data from 89 people (with a mean age of 21 years, 76.4% female) were collected at one or more of the four time-points: 18, 28, 40, and 102 months after the incident. Latent growth modelling was used to analyse levels of grief reactions and change over time, experienced need for help, and help received.Results: According to the results, the bereaved friends in our study were profoundly impacted by the loss and experienced level of reactions indicating complicated grief (mean scores on the Inventory of Complicated Grief varied from 36.2 to 23.7). A need for help was related to a decrease in grief symptoms, whereas a prolonged need for help was related to no reduction or an increase in grief. Received help was not related to decrease in grief symptoms.Conclusions: These findings underscore the need for continuous professional help, and demonstrate that the present help measures used after traumatic events may not adequately meet the needs of close bereaved friends. This emphasizes the importance of acknowledging friends as bereaved and that follow-up measures should also include this group. Finally, the study highlights the need to learn more about how professional can help bereaved friends.

Needs for help and received help for those bereaved by a drug-related death: a cross-sectional study

Background and aims: Individuals bereaved after sudden and unexpected deaths can benefit from professional help to cope after the loss, and the bereaved call for proactive, early and flexible help from professional services. Most drug-related deaths (DRDs) happen suddenly and unexpectedly. DRDs are a significant public health issue, yet few studies have examined DRD-bereaved people's needs and experiences with professional help. This article investigates the needs for help and received help reported by DRD-bereaved family members and friends, and suggests improvements in services based on the findings. Data and method: A heterogeneous convenience sample of DRD-bereaved family members and close friends (n = 255) were recruited for a survey from February to December 2018. Descriptive analyses were conducted for experiences with professional help, chi-square analyses to find predictors for help needs and received help, and logistic regression analysis to find predictors for satisfaction with the help provided. Results: Most DRD-bereaved individuals reported a need for professional help after the death regardless of family relation to the deceased, and about half of the participants received help. Nearly half of them were satisfied with the help. Our results indicated higher satisfaction with help among older bereaved, and the participants who received help from a crisis team or psychotherapist. The latter was particularly stated for younger participants. Few participants with children in the family reported that the children had received help, and less than one-third were satisfied with this help. Conclusion: The study shows that younger age groups and children need particular recognition, and a family perspective from services is essential. When assessing the help needs of the DRD-bereaved, relations of both psychological and biological closeness should be recognised. Help efforts should be tailored according to established knowledge of the provided help that bereaved populations deem effective.

Stigmatized Bereavement: A Qualitative Study on the Impacts of Stigma for Those Bereaved by a Drug-Related Death

Research has given limited attention to family and friends bereaved by a drug-overdose death. To examine the ways in which stigma may uniquely impact the grieving processes of the bereaved, a thematic analysis of 35 semistructured in-depth interviews with family members and adult peers who lost a loved one to an overdose was conducted. Our findings demonstrate that the bereaved experience stigmatization after their loss. Specifically, respondents emphasized stigmatizing interactions with law enforcement, alienation from friends and family, a lack of social support, exchanges that enforced feeling rules, and being confronted by narratives of blame and individual choice as contributing to the degrees of stigmatization they experienced. Our findings highlight how bereavement becomes stigmatized to varying degrees through multiple interactions that have a compounding effect on mourners. We refer to this process as stigmatized bereavement, whereby the frequency of such interactions informs the degree of stigmatization the bereaved faces.

Why Informal Support Fails for Siblings Bereaved by a Drug-Related Death: A Qualitative and Interactional Perspective

Drug-related deaths constitute a significant challenge that strongly impacts the lives of the bereaved and the risks of mental and social problems are well-documented. This paper is the first one to explore how bereaved siblings experience informal support after drug-related deaths. Reflexive thematic analysis is used to analyze ten semi-structured interviews with bereaved siblings. Three main themes were identified: (1) valued support elaborates on the range of desired support and content of the support received; (2) barriers to support were connected to complex family relations, different grief reactions, and stigma, shame, and devaluation; (3) ways to promote support focus on openness and mutual closeness. The discussion revolves around the 'strong' sibling role, complex family relations, stigma, protective silence, and disenfranchised grief. Interactional aspects involved in social support and the importance of addressing this in clinical practice, to utilize the vital support potential for the bereaved experiencing drug-related death, are discussed.

The Grieving Process of Opioid Overdose Bereaved Parents in Maryland

In recent years, the opioid epidemic in the United States has garnered attention due to the increasing number of fatal overdoses. Research on overdose death has increasingly focused on the psychological impacts of drug-related bereavement and disenfranchised bereavement. This study aims to contribute to the growing body of emergent literature on drug death bereavement, by exploring the experiences of parents whose children passed away due to opioid overdose. Qualitative semi-structured interviews were conducted with six parents living in the state of Maryland who had an adult child die from opioid overdose two or more years prior to the study. Data was analyzed using thematic analysis. Themes that emerged included the grieving process, stigmatization, and social support. While overall adaptation levels varied among participants, all participants reported positive and negative outcomes related to their experience of grief and loss. Implications for clinical practice and intervention are discussed.

Paths to positive growth in parents bereaved by drug-related death: A mixed-method study

Introduction

Drug-related deaths (DRDs) are a major public health challenge. Losing a child to a DRD can be a very stressful life event, which places parents at risk of mental and physical health problems. However, traumatic experiences like losing a child to DRD can paradoxically also lead to positive psychological changes. A mixed-method approach was used to understand the complexity of the phenomenon of post-traumatic growth experienced by parents following a DRD.

Method

By combining data from a survey (n = 89) and interviews (n = 14), we explored positive growth experiences among Norwegian parents. We conducted descriptive analyses of the sample’s demographic characteristics and mean scores for Post-traumatic Growth Inventory (PTGI-SF) items. Hierarchical multiple regression was used to examine the influence of the ability to perform daily activities (WSAS), self-efficacy (GSE-SF), social support (CSS), and symptoms of prolonged grief (PG-13) on the outcome variable of post-traumatic growth (PTGI-SF). Reflexive thematic analysis was applied to analyze the qualitative data. Finally, we integrated the results of the survey and the interviews.

Results

For items measuring post-traumatic growth, parents scored highest on the item “I discovered that I’m stronger than I thought I was” and lowest on the item “I am able to do better things with my life.” Self-efficacy and social support had a statistically significant relation with post-traumatic growth. Two themes were generated from the interviews: (I) new perspectives on life and (II) new paths in life. Even though the “New Possibilities” subscale had the lowest mean score for the PTGI-SF, new paths in life were important for many of the interviewed parents.

Discussion

Parents described traumatic stressors associated with having a child who uses narcotics and hence experienced positive changes even before losing their child. We argue that on an individual level, the consequences of spillover stigma, low self-efficacy, and intrusive rumination can hinder potential post-traumatic growth. On a group level, enhancing network support may increase post-traumatic growth experiences. Hence, parents who have experienced a DRD can benefit from help to activate their social networks and strengthen their self-efficacy.

Posttraumatic growth following a drug-related death: A family perspective

This paper explores the experience of posttraumatic growth in families who have lost a family member to a drug-related death. Seven family units (17 participants) were interviewed, and interviews were analyzed using reflexive thematic analysis. Analyses revealed themes that reflected positive adaptation and growth, including (a) reframing the loss, (b) open dialogue and social support, and (c) reclamation of purpose. Themes are presented in this paper for their pertinence in understanding how best to negotiate adaptation through complicated grief. The paper concludes that posttraumatic growth can occur once families begin a process of acceptance and receive support through the journey.

Does 'Time Heal all Wounds?' The Prevalence and Predictors of Prolonged Grief Among Drug-Death Bereaved Family Members: A Cross-Sectional Study

Despite rising rates of drug-related deaths (DRDs), the consequences of DRDs for bereaved family members are scarcely investigated. This study aimed to estimate the prevalence of prolonged grief (PG) symptoms in bereaved family members after DRDs, identify predictors of PG and examine whether symptom levels decrease with time. A cross-sectional design based on survey data from parents (n = 93), siblings (n = 78), children (n = 24) and other family members (n = 39) was conducted (n = 234). Descriptive analyses, a multivariate linear regression, and ANOVA were performed. 60 family members (26%) suffered from high levels of PG symptoms after DRDs (parents 31.2%, siblings 21.8%, children 20.9%). The strongest associations were found between a high level of symptoms and 'months since the loss', 'suicidal thoughts' and 'withdrawal from others'. The ANOVA analyses showed that time does not always 'heal all wounds', and the bereaved who lost one to 2 years ago had the highest level of PG symptoms.

How do Professionals in Municipal Health and Welfare Relate to Bereaved Persons During the Acute Phase of a Drug-Related Death? A Qualitative Study

This study aims to broaden our knowledge of how professionals in municipal health and welfare relate to bereaved persons during the acute phase of a drug-related death. A reflexive thematic analysis was applied to six focus group interviews with 27 first responding personnel in Norway. The article describes the complexity and simultaneousness of the professional response. Three main themes were identified: (a) establishing contact, (b) diverse, supportive assistance, and (c) a complex helping context. The analysis showed that experiences from previous encounters and the deceased’s illicit drug use affected many of the professionals’ assessments, and implied an evaluation of the bereaved as not in need of emergency services or psychosocial follow-up. Professionals should be trained to understand drug-related death as a sudden and unnatural death, and to initiate immediate psychosocial crisis intervention. There is a need for further research on the perspective of professionals in the health and welfare services on the drivers and barriers to support (bereaved persons) during the acute phase.

Prevalence and predictors of prolonged grief symptoms among those bereaved from a drug-related death in a convenience sample of Norwegian parents: A cross-sectional study

Drug-death bereaved parents are at risk of high levels of prolonged grief (PG) symptoms. We included 93 Norwegian drug-death bereaved parents in a cross-sectional survey and aimed to explain PG symptoms. High levels of PG symptoms (M = 30.69) were identified. Low level of self-efficacy and withdrawal from others were the most strongly associated with high levels of grief symptoms (p < .001). However, contrary to our expectations, social support, gender, employment, demanding life situations, and perceived proximity did not correlate significantly to PG symptoms. Our findings can enhance individual follow-up of drug-death bereaved parents.