Background

Drug-related deaths (DRDs) are a growing burden,¹ with limited international evidence of the impact of grief and the lived experience of an affected family. DRDs are associated with moral stigmas, emotional burden, shame, guilt, and complicated grief from ‘a loss that cannot be socially sanctioned, openly acknowledged or publicly mourned’.² Evidence suggests there is a need for targeted interventions in this population to explore the complex grief experienced. A 2021 study investigated the impact of complicated grief on the family system following the DRD of a family member from an Irish context.³

Method

Seven families affected by DRDs, comprising 17 family members, mainly parents, were recruited through the National Family Support Network in Ireland. Their ages ranged from 19 to 46 years (median 32 years) and the time since death of their loved one ranged from 1 to 21 years (median 9 years). Participants were interviewed using semi-structured interviews, consisting of six focus groups and one in-depth interview with a single mother. Interviews took place in the south, southeast, and east of Ireland. General qualitative interview practices were used, allowing for unprompted discussion. Interviews were conducted in the homes of the participants between August and December 2019.

Data analysis

Transcribed data were analysed using inductive reflexive thematic analysis as per Braun and Clarke’s six-step process.⁴ This approach uses a repetitive sequential process, moving between familiarisation with the data, coding, generating initial themes, reviewing themes, defining and naming themes, and writing up. The authors used NVivo qualitative data analysis software in the process. Careful consideration of the data by all authors resulted in the scope and naming of themes being agreed. Dodgson’s (2019) recommendations⁵ for quality control in qualitative research were maintained throughout the research process to avoid author influence of data interpretation.

Results

Three core themes were generated from the analysis, each with associated subthemes: (i) renegotiation of relationships; (ii) experiencing complex emotions; and (iii) adjusting to a new reality.

Renegotiation of relationships

‘Family dynamics’ and a ‘fractured sense of community’ were identified as subthemes. The trauma of a DRD on already strained family relationships can lead to a family unit breaking down or co-existing in silence following the loss. Family dynamics transition from the chaos of living with an active drug user and fractured relationships to withdrawal and an inability to remain connected to surviving members. One mother recalled:

I had three grandchildren when [son] died … but I find now that instead of helping them [pause] I kinda neglected ’em.

Another family member discussed the loss of connection:

Now his children, unfortunately, haven’t spoken to us since and we would love to have them back into our lives, you know; we tried to reclaim the family but it’s not to be because the mother has blocked it.

A fractured sense of community was described by family members from the associated stigmas and expressed feelings of loss of community.

And all the people from the area judged his parents because their son [was in addiction]. Sometimes I feel like I deserve to be punished but it’s very hard to come out the other end...

Experiencing complex emotions

Other subthemes identified were ‘lack of help during life intensifies complicated grief’, ‘the right to grieve’ and ‘relief’. The subtheme ‘lack of help during life intensifies complicated grief’ heightened the complicated grief process for the family members, leading to anger, isolation, and frustration:

I rang Dr [name] and I spoke to her …. [Doctor] asked ‘Is he coming off drugs?’ and I said ‘he’s off heroin three weeks, that’s not the problem, he’s suicidal’. [Imitates doctor] ‘Oh we don’t deal with drug cases’ … A couple of days after, I rang and I said, ‘I rang you the other day about my brother’. She said, ‘oh how’s he getting on?’ and I said ‘he’s fucking dead’ and I just hung up the phone, that was the end of it then, but I was very, very angry at her, really angry.

The preventable nature of DRDs left family members with feelings of self-blame, questioning whether they had done enough to support their loved ones. Lack of compassion from professional services left families with feelings of isolation, abandonment, and anger, giving rise to self-blame and frustration, and delegitimised their grief, as the perceived ‘bad’ death was undeserving of support.

There was nobody for me to talk to now the first time … the shame that is forced on ya because your son, you know. You didn’t deserve any of your feelings, you know, you didn’t deserve to talk about him, you didn’t deserve anything because he was a heroin addict or a junky.

Relief was a common subtheme expressed by family members at the loss of their loved ones with associated guilt:

Now when [my son] died it did break me heart but thanks be to God I knew where he was gone and maybe taken before he’s worse. I knew where he went, I was very happy. I didn’t like him to be gone but I knew where he had went.

Adjusting to a new reality

The following subthemes were identified: ‘the missing piece’, ‘illness’, and ‘new purpose in life’. The commonality of difficulty experienced coming to terms with the loss prevailed, with the feeling of a void left following a DRD:

There’s always been something missing at Christmas time... if I am ever going to get married [my only brother] is going to be missing … a part of you is gone and you are never going to regain that back.

The trauma and heavy emotional burden of a DRD can take its toll on health, as one mother recalled:

I had a brain haemorrhage after [my son] dying; they said it was the stress that caused it.

Family members also experienced new positive realities following a DRD and healing through activism was found to be helpful. Engaging with peers gave families hope, with the potential to influence change ultimately facilitating the healing process.

Discussion

This study was the first of its kind in Ireland. DRDs in Ireland are above the European average; therefore, it is important to understand their widespread impact. The study used a purposive sampling strategy that may have benefitted from a more nationwide approach, however. Time since death was listed as a limitation as recruited families were at different stages of grief and in turn levels of grief expressed. The findings demonstrate that this population experiences great difficulty in processing their grief as they struggle with family breakdown, navigate supports and stigma, and it highlights the need for a robust policy shift and direct family unit support.

1  European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) (2020) European drug report 2020: trends and developments. Luxembourg: Publications Office of the European Union. https://www.drugsandalcohol.ie/33049/

2  Doka KJ (2002) Disenfranchised grief: new directions, challenges, and strategies for practice. Champaign, IL: Research Press, p. 4.

3  Lambert S, O’Callaghan D and Frost N (2021) ‘Special death’: living with bereavement by drug-related death in Ireland. Death Studies, Early online. https://www.drugsandalcohol.ie/34409/

4  Braun V and Clarke V (2019) Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health, 11(4): 589–597.

5  Dodgson JE (2019) Reflexivity in qualitative research. J Hum Lact, 35(2): 220–222.