Article

OMEGA—Journal of Death and

Grief and Healing Dying

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Drug-Death-Bereaved DOI: 10.1177/0030222818754669
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Parents

William Feigelman1, Beverly Feigelman2,

and Lillian M. Range3

Abstract
We explored parents’ views of the trajectories of their adult children’s eventual
deaths from drugs with in-depth qualitative interviews from 11 bereaved parents.
Parents reported great emotional distress and high financial burdens as their children
went through death spirals of increasing drug involvements. These deaths often
entailed anxiety-inducing interactions with police or medical personnel, subsequent
difficulties with sharing death cause information with socially significant others, and
longer term problems from routine interactions. Eventually, though, many of these
longer term bereaved parents reported overcoming these obstacles and developing
posttraumatic growth. Openly disclosing the nature of the death seemed to be an
important building block for their healing.

Keywords
death, drug overdose, bereavement, posttraumatic growth, death spiral

Epidemic is a particularly apt term to describe the recent spectacular rises in

drug poisoning fatalities in the United States. A 2015 survey reported a 137%
rise in drug fatalities between 2000 and 2014, and a 200% spike in opioid fatal-
ities (Rudd, Aleshire, Zibbell, & Gladden, 2015). According to preliminary

1
Nassau Community College, Garden City, NY, USA
2
Private Practicing Psychotherapist and Bereavement Counselor, Jamaica, NY, USA
3
Holy Cross University, New Orleans, LA, USA
Corresponding Author:
William Feigelman, 181-34 Aberdeen Rd., Jamaica, NY 11432, USA.
Email: feigelw@ncc.edu
2 OMEGA—Journal of Death and Dying 0(0)

Centers for Disease Control information, the United States is on a path to

exceed 60,000 drug deaths in 2016, a 20% rise from the previous year, bringing
drug deaths way beyond the numbers of yearly traffic fatalities (40,000) and or
yearly suicides (44,000; American Association of Suicidology, 2017; Centers for
Disease Control, 2017; National Safety Council, 2017). Drug deaths are a
common tragedy in 2017.
At the same time, American society has reconceptualized drug addiction
away from its origins in the criminal-legal system into a medical or psychiatric
framework. There has always been a duality to drug addiction, with society
viewing it both as a criminal problem and as behavior problem requiring
social services (Murphy, 2015). As the Affordable Care Act and Medicaid expan-
sion have extended new treatment opportunities to more drug-dependent per-
sons, the pendulum has begun to swing toward offering care and treatment
rather than incarceration. Thus, hundreds of thousands of drug-troubled
people are finding new opportunities to obtain medical and psychiatric help.
Only a handful of studies exist on the mourners of drug-death decedents. A
recent comprehensive review of this limited literature emphasized the obstacles
to making sense of the loss through sharing it with others and finding comfort in
the deceased person’s memory and recommended further exploration of the
large gaps in understanding how families and individuals experience and
grieve such deaths (Valentine, Bauld, & Walters, 2016). In many ways, this
perspective was the starting point for the present investigation.
An important theme of previous studies is that many drug-death-bereaved
people experience disenfranchised grief, which is when society does not acknow-
ledge and support a mourner’s grief, thereby worsening the grieving experience
(Doka, 2001). In a comparison of different causes of death, those bereaved from
drug or suicidal deaths reported more grief and mental health problems than
those bereaved from accidental and natural deaths (Feigelman, Gorman, &
Jordan, 2011). Also, half of drug-death-bereaved parents reported hearing state-
ments blaming either the child or the parents for the drug death, compared with
only one or none when a child died from an accident or natural causes
(Feigelman et al., 2011). However, the Feigelman et al. study involved extensive
questionnaires, but no actual interviews, which would enable a finer examination
of the trajectory of grief and healing. Also, all the participants came from a
single source, the Compassionate Friends Grief Support Groups. Getting par-
ticipants from many sources would give a clearer picture of the trajectory of the
experience for drug-death-bereaved parents.
In a study of 106 drug-death mourners from Great Britain and Scotland, many
reported receiving stigmatizing comments from friends and family members such
as referring to the deceased as a ‘‘junkie’’ or ‘‘drug addict’’; consequently, mour-
ners often misrepresented their loved one’s death cause to protect themselves
emotionally, and by doing so, denied themselves validation and support for
their losses (Valentine, 2018, pp. 77–84). For these people, disenfranchised grief
Feigelman et al. 3

negatively impacted bereavement and support seeking, clearly suggesting that

marginalization hindered their healing (Templeton et al., 2016). Among a subset
of 32 of these bereaved adults, those living with a loved one’s substance use prior
to their deaths reported difficult circumstances surrounding the death, having to
negotiate complex procedures in processing the death, experiencing stigma that
such deaths attracted, and having feelings of guilt, self-blame, and an unworthi-
ness to grieve (Templeton et al., 2017). These findings, based on a large and diverse
sample, are very important for explaining shorter term coping and support-seeking
afterward but less valuable for enhancing viewpoints on the longer term healing
trajectories and posttraumatic growth of those bereaved from drug death.
In the present study, based on previous work with longer term suicide-
bereaved parents (Feigelman, Jordan, McIntosh, & Feigelman, 2012), we sus-
pected that longer term drug-death-bereaved parents (whose losses had occurred
5 or more years previously) would be more amenable to posttraumatic growth
than shorter term bereaved parents (whose deaths had occurred within the pre-
vious 3 years); also, another important element would be examining the trajec-
tory of the drug death for the mourner, as anticipating the death might lead to
both relief and guilt after the death.

Method
Participants
The 11 interviewees (9 mothers, 2 fathers) were recruited from different individ-
uals and organizations that provide support to drug-death mourners, including
professional counselors (n ¼ 4), and relevant organizations including Survivors
of Suicide Support Groups (n ¼ 2), drug treatment and recovery support groups
(n ¼ 2), Facebook and Group for Recovery After Substance Abuse Passing
(GRASP; n ¼ 2), and Compassionate Friends (n ¼ 1). Interviewees were aged
59 to 74. Most were college graduates, working at or retired from professional
positions such as guidance counselor, social worker, teacher, financial analyst,
accountant, salesperson, and small business owner.
Children who died from drug-induced causes (10 men and 1 woman) were on
average age 26.8 at the time of their deaths, White (all), heterosexual (n ¼ 10),
and biological offspring (n ¼ 10). Slightly over half were from divorced parent
households (n ¼ 6) and were described by parents as underemployed or unem-
ployed during the years immediately prior to their deaths (n ¼ 6). They died
anywhere from 9 months to 21 years previously (M ¼ 6 years).

Procedure
The first or second author completed interviews at the interviewee’s home, the
author’s home, nearby restaurants, or by phone. Researchers contacted the
4 OMEGA—Journal of Death and Dying 0(0)

drug-death bereavement community seeking volunteers to participate in a 1- to

2-hour interview about the loss of their child to drugs. We asked mental health
counselors with drug-death-bereaved patients to recruit volunteers from current
or former patients, and we asked members of relevant support groups to par-
ticipate. The first author interviewed support group members; the second author
interviewed patients or former patients. The interview included (a) obtaining
basic demographic information on the bereaved parent and the deceased
child; (b) asking about any experiences of being stigmatized, humiliated, or
avoided after their child’s death; (c) inquiring whether the interviewee disclosed
or concealed the cause of their child’s death and any changes in disclosure over
time; (d) outlining their child’s evolution from first using drugs till death; and
(e) indicating how their activities, goals, and social contacts evolved since their
child’s death including listing any activities to memorialize their child.
All interviews were transcribed, carefully examined, and organized around
the five themes listed earlier with additional subthemes added for such subjects
as applying tough love and the approximate time length of the death spiral, and
so forth. Responses were listed on an Excel spreadsheet where we discerned
response patterns showing more newly bereaved persons reporting more
instances of concealing the deaths, more cases of being stigmatized and humi-
liated, and fewer descriptions of their own posttraumatic growth compared with
longer term bereaved persons.
At the outset of each interview, whether it was conducted in person or by
telephone, which only applied to two cases, respondents were advised that if they
found any of our questions unsettling or disturbing, they did not have to answer
those questions. All were asked to verbally confirm their participation in the
research and were told that their names and any significant details that might
help to identify them would be changed to fully protect their privacy and con-
fidentiality. During the interviews, both interviewers did not use any electronic
devices to record these events. All interviews were transcribed by hand, necessi-
tating periodic pauses so that the interviewers could catch up to what the
respondents were saying. Once all the interviews were completed, participants
were presented with draft copies of the results and were invited to suggest
changes to correct any errors or misinterpretation that had taken place. Only
three respondents offered corrections to further explain their behavior and
redress initial misinterpretations. At the conclusion of the data gathering pro-
cess, about half of the respondents expressed gratitude that their loss stories
were being heard (perhaps for the first time) and that they were able to contrib-
ute to this process; another expressed gratitude that her son’s life was being
memorialized positively, and another respondent jokingly suggested that her
former friend might read her story about being cast aside after her son’s drug
death and feel remorseful about her rejection.
After the data were collected, we provisionally wrote up the results following
the outline we had developed for the interviews. After sharing this draft among
Feigelman et al. 5

the coauthor team, one member of the group envisioned a new ordering of
results, presenting them chronologically. Subsequently, a draft was prepared
following this diverging plan, and once all members of the team viewed the
alternative formulation, all agreed this presented a far more meaningful and
superior organization of the results than the earlier scheme.

Results
This section summarizes the findings from the in-depth interviews. We discuss
the results chronologically. First, we mention the death spiral; this is when,
perhaps for the first time, the parent becomes painfully aware of the lethal
potential of their child’s drug use. For our respondents, it may have occurred
when one mother discovered one of her son’s letters to a friend where he
described his deep dependency and inability to stop using drugs or another
mother’s discovery that her drug-addicted daughter stole and sold her coveted
record collection of 60 s and 70 s Beatles’ music. The Death Spiral awakens in
the bereaved person’s mind a feeling that this child might die from drug-related
complications. This period is followed by the Crash, the cataclysmic event of the
death. Next comes the task of initially sharing the details of the death with close
friends and family. Following this period, there are longer term routine situ-
ations that occur and occasionally pose healing-related difficulties for the
bereaved. Memorialization and Posttraumatic Growth comes last. This last
stage did not apply to some of our shorter term (less than 3 years) more recently
bereaved interviewees.
These parents reported that their child’s drug involvement went into a death
spiral. When parents learned of the death, relevant official personnel often trea-
ted them insensitively. Most parents found sharing the details difficult, a prob-
lem that seemed to recur in later routine situations. Nevertheless, some parents
overcame these obstacles to experience posttraumatic healing and growth.

Death Spiral
Each informant offered a unique story of the trajectory of their child’s initial
uptake of drugs leading to the eventual death. Some parents had long, tortur-
ous experiences with their children with multiple relapses, difficult incidents
such as thefts of family property, humiliating experiences such as bailing their
child out of jail, and seeing their children struggle against the dominance of
drugs.
Lenore reported a typical scenario:

Matthew grew up in an intact family, a middle child in a three-child family.

When he started high school, he was an honor student and played on the
lacrosse team. He was hoping to get a scholarship to play lacrosse in college.
6 OMEGA—Journal of Death and Dying 0(0)

Then, during his high school sophomore year, the stability of his social world
collapsed with my divorce from his father, revealing that my ex- had severe
problems with gambling and drugs. This was followed by three of Matthew’s
four grandparents dying within a 3-year period. All these changes led to
Matthew’s drug taking. At first, Matthew started with cigarettes, marijuana,
and beer. But, it wasn’t long before, under the laissez-fare care of his father,
Matthew’s drug use changed to pill popping and heroin use. I tried to get PINS
(Person In Need of Supervision) petitions for each of my kids while they were
minors, to prevent them from staying in their father’s unregulated household, but
I was unsuccessful. Before I knew it, Matthew just barely finished high school
and went into his first drug treatment right after high school. From age 19 till his
death (at age 21), my son attended several outpatient rehabilitation programs,
several 5-day detox programs, and two 28-day inpatient programs. His longest
sobriety was 9 months at age 20. He never thought he was addicted when he
went to the treatments; he felt he could stop it at any time. Matthew’s main
feeling was that he was a deep disappointment to his family; he used drugs to
escape his near constant self-torment for failing. He overdosed at home in his
own bed, and my younger son found him. When Matthew died, he was awaiting
entry into another 28-day inpatient program. Who knows if that program could
have saved him?

Likewise, Harold said,

I spent over $200,000 for special schools and treatment programs for Robbie.
Robbie was always breaking things and getting into trouble. Once he conned me
into getting him an expensive electric guitar. I learned a few months later that he
pawned it for drug money. I’d call him regularly to see how he was doing, and
occasionally I found him under the influence of drugs; whenever I confronted him
about it, he’d bark at me. Eventually, for self-protection, I had to keep my distance
from him.

The drug involvement was sometimes so intense parents anticipated their child’s
death.

Pauline said,

I would often go around ‘‘waiting for the shoe to drop’’ so to speak, anticipating
John’s death. I’d go around in a fog sometimes, thinking about it, waiting for the
next catastrophe. One time, when I was on my way home, thinking about him,
worrying about what I’d find when I opened the door, I wasn’t paying close atten-
tion where I was walking, and I tripped and fell; my injury required surgery, and I
was incapacitated for months afterwards.
Feigelman et al. 7

Charlotte said,

Despite his biological father’s departure at age 3, Tim grew up in a relatively stable
home. He was not much of a student, dropped out of high school, [and] joined the
Army where he completed his GED. His drug problems did not start until he
finished his army tour and was given OxyContin for chronic pain relief instead
of the back surgery that he should have been offered. Tim moved onto using street
drugs afterwards and was charged for three different offenses. I was able to get him
bailed out for two of the charges, but he had to serve the third charge, 2 years in
prison. When he was in jail, I kept sending him money every week to keep him safe
and to keep his spirits up; I was also afraid he might have taken his life, otherwise.
In jail, drugs were widely available, so some of my money probably fueled his drug
habit, but I felt I had no choice. Thousands were spent for this and for bailing him
out at different times, and I’m still in debt from doing all this. Shortly after Tim was
released from an early jailing, he came back to live in my (and his step-father’s)
home. But not long afterwards, we had no other choice but to change the locks at
our home because we couldn’t stop Tim from stealing from us, credit cards, cash,
anything of value. I wanted him out of my house, but when I gave him over to his
biological father, instead of taking him into his house and supervising him, he
brought him over to live with my elderly mother. He remained there for the next
several months before he wound up in jail again. His final 2 years were spent in jail,
at my home, jail briefly again, and finally he died at his drug dealer’s house at age
34. Tim was primarily a heroin addict; he had been twice saved with Narcan from
overdosing.

Barbara reported that

Within a month before his death, I sat down with Kevin and had a serious talk with
him after his second near-fatal OD from heroin. I guess you want to die, how do
you want me to handle your death and funeral when it happens, I asked. I was
surprised that he had an elaborate and thought out answer for me. He said I don’t
care if you have a funeral service for me or not, but please cremate my body and
take part of my ashes and have them made into a diamond. I said I would honor his
wishes. After he died, I found out there were only two companies, one in Illinois
and another in Great Britain that made diamonds from cremated remains. [She
proudly pointed to a platinum broach attached to a necklace with a diamond in it.]

In contrast, Frank reported an atypical scenario:

My son Michael was living in his own apartment with his girlfriend before his
death. He was a college grad and thought of himself as a budding writer. He
had saved up a lot of money from his job and decided to make a grand tour of
8 OMEGA—Journal of Death and Dying 0(0)

Europe and Asia to broaden his horizons. It sounded like a good idea to me. I
didn’t know the extent of his previous drug taking. For all I knew he probably
drank alcohol heavily, smoked pot, and may have taken other drugs like LSD or
tranquillizers, like many other young people did. When he and his girlfriend were
traveling around in India, Michael had a drug-related seizure on an important
religious holiday, and he couldn’t get to see a doctor in the big city hospital
where he fell sick. The next thing I heard was that he had died, and we had to
transport his body back home for burial. He was only 24.

As their children became more and more involved with drugs, most of these
parents realized that death was a possibility. These parents hoped that death
would release their child from their near constant pain of living.
Most of these parents knew about tough love, which would be defined as
turning their backs on their child temporarily to avoid becoming enmeshed in a
cycle of codependency. Sally reported that she and her husband applied tough
love to David after his first hospitalization:

We said to him you can’t come back to live here again unless you stay in treatment.
I don’t think he was able to do that then. So he got his own apartment where he
lived for the last 3 years of his life.

In contrast, Maria seemed bewildered by a question about tough love; the term
was unfamiliar to her. When the interviewer reframed the question, Maria
reported never denying (her daughter) Adrienne entry into her home and
never thinking of doing so, despite Adrienne’s history of occasional thefts of
money and other family valuables. Note, Maria’s home had been a safe harbor
for other family members struggling with drug abuse. Maria’s husband, pres-
ently sober, had abused alcohol during the early years of their marriage, and
Maria’s other child was temporarily living in Maria’s home after being kicked
out of his own home for drug involvement.
The contrast between families was striking. In Sally’s family, her son
David was the only family member with a history or current involvement
with drugs. In Maria’s home, however, at least two other family members
had histories or current drug problems. Likewise, even though Charlotte
changed the locks, thereby denying Tim entry, Tim eventually stayed at his
grandmother’s home, where his substance-abusing uncle was living. It
appeared that tough love policies were less likely in families with multiple
members involved with drugs.
Overall, many parents reported that their child’s drug involvement came at
great cost emotionally and financially. Those perceiving the death as resulting
from illness, or a poorly understood brain disease, seemed relatively more able
to honor the deceased person’s life and remember the joy they brought to other
family members. Those perceiving the death as a life style choice seemed
Feigelman et al. 9

relatively less able to positively frame the deceased person’s life. For example,
one person said ‘‘we will not talk about them any further, since it only makes us
angry and sad.’’ Some parents struggled between these two polar responses to
the death.
Summing up this section, as many parents perceived their child in a death
spiral, discovering the seriousness of their addictions, a good many, a majority
possibly, resolutely began to anticipate the deaths.

Crash
Finding the body and interacting with personnel from police and the medical
examiner’s office was very difficult. Generally, police officers offered little to no
compassion or support and defined the death site as a potential crime scene. As
Maria put it,

I discovered Adrienne’s limp body on the floor of her room and also saw the
hypodermic needle in her hand. Initially, I was in shock and immobilized, and
my grandson, who was living with us at that time, called the police. Once they
arrived, they wouldn’t let me go near her. I wanted to fix her hair and take it off her
face. I wanted to see that her eyes were closed and that she looked peaceful, but
they wouldn’t let me get close to her. They carted her off in a body bag. I ran after
them to give them the needle that fell out of her hand. I had a sharp disagreement
about everything they were doing in my home and with one younger policeman in
particular, but an older policeman eventually calmed things down between us. All
the police were very businesslike about it. Not a single one of them had any
consoling things to say to me. Imagine, a young, 30-year-old woman dies, and
no one has a kind word to say about it to the mother. All I can say is they were
very cold and business-like.

Another mother, Betty, reported:

My husband and I learned about our son Mack’s death from one of our son’s
friends who lived in the same apartment building where he lived. We later found
out that Mack died from a cocaine-induced hanging. When we arrived at his apart-
ment, yellow crime scene tape was draped around the doorway, preventing us from
entering the apartment. We stood by to see Mack’s body carried out in a body bag
and were told to report to the county medical examiner’s office to identify the body.
At the office, we were shown a photograph of Mack and asked to identify him that
way. We didn’t want to identify him from the photo and asked if we could see
Mack in the morgue. The agent there told us that the official ME (Medical
Examiner) policy only permitted photo identification. We then insisted on speaking
to an administrator who eventually granted us an opportunity to actually see
Mack’s body.
10 OMEGA—Journal of Death and Dying 0(0)

Another mother, Pauline, reported finding her deceased son’s body:

I saw John’s body on the living room sofa. I called his name, struggled to turn him
over, and found his face to have a mottled appearance to it. I shook him and tried
to push him upright. I saw he wasn’t breathing, but I hit his chest, even though I
knew nothing was going to happen; I had to do it. Then, I called the police. I was
all by myself at the time, and it was terrifying.

Naturally, these parents were horrified to find their child’s body or learn of their
child’s death. In addition, these parents reported difficulties with how people
treated them at this moment of crisis. Those who were the first to find their
child’s dead body (and alone at the time) appeared to experience the most pro-
found distress.

Initially Sharing the Details

Many respondents reported difficulties in openly talking about their child’s drug
death with others. Either parents or other close family members believed that
openly discussing the drug involvement would dishonor their deceased child’s
memory. Some felt it was shameful to have a child die this way.
Sally reported:

I had no qualms about talking about my son David’s death and saying that it was a
drug overdose, but my husband Peter was deeply ashamed of it. To this day, 12 years
after the death, he has never told his coworkers how David died. He said David had
some heart malfunction and that caused his death. He didn’t want David’s memory
to be sullied in any way. He even told this same story to his relatives about David’s
death. But, behind his back and on the q.t. (meaning on the quiet or secretly), I felt I
had to tell them the real reason, which we never talk about in front of Peter. Peter
has always gone very quiet about David’s death. He didn’t interfere with my support
group participation and my ongoing writing, which is usually done anonymously,
but he doesn’t want to get involved in any of these grief support activities himself. I
have to respect his own different way of grieving from mine. My surviving son,
Albert, 2 years older than David, has always been open in acknowledging David’s
death from drugs. Shortly after David died, I was very angry with him for causing
my husband such shame and agony, but as time passed, my anger to David faded. I
have to respect Peter. I try my best not to embarrass him by talking openly about the
death in front of him. I don’t want to throw it up in his face.

Similarly, Pauline reported:

After I found John’s dead body on the living room couch, I thought he may have
had a massive heart attack like his father, who died that way 4 years ago. But I was
Feigelman et al. 11

trying to fool myself, I guess. I knew very well that John was abusing drugs. He had
been in and out of rehabs for several years and had spent his entire inheritance of
$50,000, after his father’s death, on cocaine. As I said, I hoped John had died from
an [sic] coronary embolism like his father, but when John’s toxicology report came
back a few months after his death, it showed cocaine. And there it was in black and
white—so dreadful to have that information. I was wiped from it. After I got that
report, I stayed home for several days. I only told just a few close friends and my
therapist how he really died.

Ramona said:

Everybody knew my boy was a sensitive and gentle soul. He suffered from depres-
sion and social anxiety, both helped by his prescribed medications. But, no one but
me (and my psychiatrist) knew about his use of street drugs toward the end of his
life and that he had died as a result of overdosing on his prescribed meds plus
fentanyl. At the funeral, I just wanted to focus on the beautiful things in Darin’s
life: his humane caring for people and animals and his gentle, quiet manner. We
had a lovely service for him at our local church with friends and relatives honoring
him. Even now, amongst my small group of very close friends, I continue to with-
hold the complete story, that Darin had died from an overdose of street drugs—I’m
afraid it will only diminish their respect for him.

These parents reported that relatives and friends often rejected or avoided
them entirely after their child died. People did not know what to say to the
bereaved person, so said nothing. When confronted, potential comforting
people said things like, ‘‘I thought you wanted to be alone’’; and ‘‘I didn’t
think you wanted company right now.’’ These parents often had trouble
sharing death details and did not get help in doing so. In the early months
after loss, many drug-death-bereaved parents found it easiest to conceal from
others the fact that their child died from a drug overdose.

Longer Term Routine Situations

Even over time, these interviewees reported awkward interactions with others.
Several respondents reported rejecting responses from people they had con-
sidered close friends. For example, Ellen said,

Betty and I had been close friends ever since our children were very little. Betty
always said I was her best friend. We carpooled together when the children were in
kindergarten and primary school; we sent our kids to the same summer camps and
had even spent several family vacations together—I considered her a good friend,
as well. When Marshall died of a drug overdose, Betty and her husband came to the
funeral and made a shiva call afterwards. They brought lots of food. Then, for the
12 OMEGA—Journal of Death and Dying 0(0)

next 4 months, I never heard from Betty again until she called me to mention her
daughter’s upcoming baby shower. She indicated that the date was on my son’s
birthday and hinted it might be too much for me to attend. I agreed and declined
the invitation but sent a baby gift. After the death, I was a bit of a basket case; I
had put on a lot of weight and was teary-eyed much of the time. I really needed all
of my friends’ help and support when I was so fragile. A few months after the death
and still not hearing much from Betty except for the baby shower invitation, I left a
message on her answering machine but never got a call back. I guessed that Betty
was pulling away from me, and later this was confirmed. Two years after the death,
my surviving son ran into a mutual friend of Betty’s and mine and mentioned to her
how upset I was from not hearing from Betty. This woman took it upon herself to
question Betty as to why she hadn’t called me. My other friend told me that Betty
just shrugged it off when confronted and said we were never that close, even before
my son’s death.

Pauline described a similar situation:

My son John played an important role in guiding this young man (Jack) to treat-
ment several years earlier. The two boys had been well acquainted with each other,
and I knew that Jack must have learned from mutual friends that my son had died
of an overdose. When I met up with Jack at a social event and went over to hug
him, he seemed uncomfortable, awkward, and pulled away. Maybe he was feeling
guilty at having survived his own drug use. He didn’t seem to know what to
say—but all he needed to say to me was I am sorry.

Harold reported:

I don’t know if it was my son Robbie’s drug death that caused my being let go from
work, but it could have been. After my son’s overdose death, I took some time off
from work to arrange for the funeral and burial. And frankly, when I came back to
work, although I wasn’t the same old cheerful, upbeat guy I may have been pre-
viously, I thought I was doing my job conscientiously as always. My boss never
asked how I was feeling after the death. He just kept hounding me with questions,
first right after the death, when are you coming back to work and when I was back,
he occasionally commented that I didn’t have my old zest and sparkle. How would
anyone act two or three weeks after their child’s death? Several months later, I was
given a pink slip . . .

Harold added more information on how his family handled grieving:

In my family, it has always been that when someone dies, their pictures get taken
down, and no one talks about them anymore—that’s the way it was after my father
died at age 40. My mother was not one to dwell upon the dead. So we never talked
Feigelman et al. 13

about my deceased son either, not with my ex-spouse, my daughter, and my new
girlfriend. Thank goodness for the support group where I finally have a chance to
talk about my boy.

Betty described a routine family medical history query.

When the doctor asked me how many children I had, I told her I had two. One, my
43-year-old daughter who was married and had two children herself, and my son,
who died 15 years ago from a drug overdose. The doctor, visibly uncomfortable,
told me we didn’t need to talk about that child. I gave her a piece of my mind and
set her straight about the importance of all children in any family.

Betty further described a staff meeting,

One of the addiction treatment personnel proposed that more Narcan administra-
tion training be offered within the community to help those who relapse after
discharge. One of the psychiatric residents quipped in response: ‘‘Why don’t we
just focus on the patients who are motivated to get well. What’s the point of
wasting our time and resources? These addicts are only going to relapse again
and maybe die anyway, at some later date.’’

Barbara described an online situation:

After Kevin died, I went on Facebook and found that some of my Facebook
friends criticized me for openly talking about Kevin’s overdose death from
heroin. They said I wasn’t grieving properly, whatever that meant; they said,
‘‘What do you want to talk about that for? What good will it do now, he is already
gone.’’

Even people close to these parents had a hard time responding. Charlotte
said,

About 8 months after Tim’s death, I was talking to my mother, expressing my

sorrow and guilt at what I should or could have done to save him. My mother said
something that caught me by surprise. She said ‘‘Isn’t it time you let go of this?’’ I
thought my mother, of all the people in this world, would understand my grief and
remorse. After all, her own son (my brother) had died of a drug overdose a few
years back. I couldn’t believe her! And she had always remarked that Tim was such
a delight to have around; he lit up the room. I felt so hurt.

These parents reported that even after time passed, those who could offer com-
fort failed to do so. Various routine situations were awkward, and people some-
times avoided these parents entirely.
14 OMEGA—Journal of Death and Dying 0(0)

Memorialization and Posttraumatic Growth

Despite serious obstacles, many of the longer term bereaved parents eventually
experienced some healing and posttraumatic growth. Many described some kind
of memorial to their deceased child. For example, Barbara said,

Personally, I never felt any shame or at fault about Kevin’s death; we got him the
best treatments that money could buy at that time. Eventually, I went to the recov-
ery support groups where people embraced me and wanted to hear my story about
losing Kevin. I had always thought of starting a foundation to memorialize Kevin.
I soon partnered with another man in recovery, who knew Kevin. He and I even-
tually started by making donations to promising recovery candidates trying to get
them into recovery somewhere. We created a 501-C3 organization, advertised on
Facebook, and soon donations started trickling in. Some people gave $5 a month
and others $500 or more. So far we’ve raised over $240,000 and have served 286
young people, helping them with their transportation and other expenses to get to
South Carolina mostly, where most of the treatment programs we refer to are
located. Most all of these young people we helped are still drug-free and feel greatly
indebted to us when no one else cared a hoot for them. Two years ago, we were
honored by a cosmetics company who gave me a Woman of the Year Award. We
put the monetary part of the award back into the foundation. I think Kevin would
be proud of the work we are doing. I couldn’t think of a better way to honor his
memory than by doing this.

Likewise, Ramona reported,

Darin had volunteered all through high school at an animal shelter and was hired
there after graduation. He planned to make this his career. After his death, I sug-
gested that all donations people wanted to make in his memory be offered to this
shelter. After his funeral, I was moping about the house, isolated and feeling
depressed. I didn’t know what to do with myself. I was widowed, had left my
job to care for Darin’s downward emotional spiral, and now had lost my only
child. A month later, the director of the animal shelter called, thanking me for
the generous memorial donations the shelter had received. He spoke affectionately
of Darin, remembering his loving and competent care of the animals. He then
asked how I was doing and suggested that I could work part time at the shelter.
It was like he threw me a life line. I was so grateful for this opportunity to do
something useful. At first, I was primarily at the front desk receiving injured or
abandoned animals and comforting the rescuers who brought them in. This work
and environment felt very therapeutic for me. I felt connected once again. The
director knew that I had computer and other business skills and after several
months of part time work, offered me a full time position. I feel so lucky to be
closely affiliated with this shelter’s growth and truly believe that I am carrying on
Feigelman et al. 15

the work that my son felt was meaningful and important; I feel I am memorializing
Darin in a very positive way.

Lenore reported,

After Matthew died, I was quiet at first. During those early grieving days, I wrote
an op-ed piece for the local county newspaper which elicited numerous negative
comments disparaging Matthew. These responses were very hurtful. I went to a
Compassionate Friends group, and I soon tired of that—I didn’t want to dwell
on the loss and talk about it endlessly. I knew I wanted to do something positive
for Matt and start a foundation memorializing him. I wanted to feel joy in the
knowledge I had him for 21 years and not get bogged down with all the negative
things connected with his drug death. In the first year after Matt’s death, our
fund-raising efforts brought in $12,000. I was in close contact with some of the
local recovery organizations some of whom do advocacy work at the state capi-
tol. I wanted to do this, too. Before I knew it, I was part of one of the teams that
went up to the state capitol lobbying for wider distribution of Narcan in our
state, for more drug treatment opportunities and so forth. When we met with
legislators, I would usually bring along my small container with some of Matt’s
ashes in it. With this in front of them, the legislators found it difficult to dismiss
us so easily. I’ve been on several teams going up to the capitol periodically. Now,
we’ve got all EMT workers and the police trained and carrying Narcan with them
throughout the state. We also successfully got another new law passed so that
medical professionals, and not just law enforcement, can now mandate patients to
drug treatment. With the new law, treatment can now be covered by medical
insurance policies. When Matt died, he was not rated high enough by our insur-
ance policy to be entitled to treatment. There are so many issues that we still need
to address. I can’t think of a better way to memorialize Matt than by what I am
doing now.

Frank reported:

When Michael died 21 years ago, there were no groups on the Internet and the only
grief resources available were seeing a grief counselor or joining a Compassionate
Friends group. My wife and I found Compassionate Friends very helpful, and we
became involved in a chapter near our home. After a couple of years of being in the
group, the previous leader moved out of state, and I was elected as chapter leader,
which I have been for the last 15 years. There’s a lot to it: running the monthly
meetings, meeting with newly bereaved members at a diner about a week before the
meetings, doing the newsletters and organizing our few annual events like getting a
group together to go to the national conferences, doing our balloon release event,
and our annual holiday get together. When I was working, it was sometimes a bit
hectic doing all these things, but now that I’m retired it is no problem at all . . . It is
16 OMEGA—Journal of Death and Dying 0(0)

now up to veteran bereaved like myself to help the newly bereaved along with their
healing journeys.

These memorials seemed to start with parents being able to share the details of
their child’s death. Those who were able to experience some healing had done so
only after some time (usually about 3 or more years after the death) had passed.

Discussion
This report focused attention on the grief and healing trajectories of U.S.
drug-death-bereaved parents. These 11 parents whose adult children died
from drug deaths often anticipated the death in the long death spiral their
child experienced. These findings converge with a study in Brazil where family
members experienced a ‘‘veiled preparation’’ for possible death among their
drug-involved loved ones (Da Silva, Noto, & Formigioni, 2007) and with
another study in the United Kingdom and Scotland where close relatives
often reported anticipating the death (Valentine, 2018). The British group
used the term living bereavement to refer to this anticipation of the death. In
contrast, in a U.S. study, 80% of parents bereaved from a suicide death
reported being extremely surprised or blindsided at their child’s suicide
(Feigelman et al., 2012). A child’s death from drug involvement is often the
end of a long trajectory of bad experiences.
These parents had diverging ideas on tough love. If all other household mem-
bers were free from drug abuse problems, applying tough love seemed more feas-
ible than if other family members also had past or present drug problems. This
assertion converges with findings from the UK study (Valentine, 2018). The British
group observed that when concurrent drug abuse problems were present in other
family members, stress and coping were more difficult for all family members.
Among these 11 parents, healing and growth seemed accelerated when the
parents were able to openly disclose the details of their child’s death. Sharing
these details with others seemed to enable them to assume leadership positions in
peer support organizations like Compassionate Friends, to advocate for better
treatments for drug-troubled individuals, and to support others newly bereaved
from drug death. These findings converge with data of people bereaved from
either suicide or drug death, showing that those who openly disclosed the cause
of their loved one’s death had significantly fewer grief difficulties and viewed
their mental health more positively, compared with bereaved others who con-
cealed the death cause (Feigelman, Cerel, & Sanford, 2017). Present respondents
viewed their advocacy and compassion for others as satisfying and an important
commemoration of their child’s life.
Present results are limited in that all interviewees were among parents who
sought some sort of treatment after their child’s death, either by seeing a ther-
apist or joining a support group. Parents who do not reach out in this way, or
Feigelman et al. 17

who are unwilling to be interviewed, may respond differently. The present study
also overrepresented bereaved mothers; having more women than men is
common in bereavement studies. Also, as is true in the majority of drug
deaths, the deceased person was a man. Future bereavement studies drawing
on official death records sources might more accurately represent the bereaved
population at large in terms of its sex ratio and treatment-seeking histories.
Although this study suggested that drug-death-bereaved may confront unique
healing challenges associated with anticipating their children’s deaths, we have
no basis for supposing that they will find healing any more problematic than
others traumatically bereaved. At least two surveys, following up traumatically
bereaved parents 5 or more years after the deaths of their children, found dimin-
ishing grief problems, complicated grief, and depression as time after their losses
had passed (Feigelman et al., 2012; Murphy, Johnson, Wu, Fan, & Lohan,
2003). Previous studies have also shown with more time after loss elapsing,
traumatically bereaved parents were more likely to show better mental health
and more posttraumatic growth (Dyregrov & Dyregrov, 2008; Feigelman et al.,
2012). The evidence obtained in this qualitative study suggests that as time after
loss passes, drug-death-bereaved parents, too, much like traumatically bereaved
others, are able to arrive at a ‘‘new normal’’ and make important and worthy
contributions reflecting their own posttraumatic growth. For these mourners, it
is an important task to positively memorialize their deceased children by their
posttraumatic growth activities. Present findings suggest that for those whose
loved one died from drugs, helping others advances their own healing. It also
appears that better adaptations will occur when drug-death-bereaved parents
disregard stigmatizing claims that their deceased loved one was at fault and
instead believe, as many drug-death-bereaved do, that addiction deaths reflect
poorly understood brain diseases or that addiction itself is a bona fide disease
much like cancer or heart disease. Ultimately, with sharing precepts such as
these, there is almost no limit as to what most of these survivors will be able
to accomplish as they act to promote their own posttraumatic growth.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publica-
tion of this article.

References
American Association of Suicidology. (2017). USA Suicide: 2016 Official Final Data.
Retrieved from http://www.suicidology.org/resources/facts-statistics
18 OMEGA—Journal of Death and Dying 0(0)

Centers for Disease Control. (2017). Provisional counts of drug overdose deaths, as of 8/6/
2017. Retrieved from https://www.cdc.gov/nchs/data/health_policy/monthly-drug-
overdose-death-estimates.pdf
Da Silva, E. A., Noto, A. R., & Formigoni, M. L. (2007). Death by drug overdose:
Impact on families. Journal of Psychoactive Drugs, 39, 301–306.
Doka, K. J. (Ed.). (2001). Disenfranchised Grief: New Directions, Challenges and
Strategies for Practice (2nd ed.). Champaign, IL: Research Press.
Dyregrov, K., & Dyregrov, A. (2008). Effective grief and bereavement support. London,
England: Jessica Kingsley.
Feigelman, W., Cerel, J., & Sanford, R. (2017). Disclosure in traumatic deaths as correl-
ates of differential mental health outcomes. Death Studies. Advance online publica-
tion. doi:10.1080/07481187.2017.1372533
Feigelman, W., Gorman, B. S., & Jordan, J. (2011). Parental grief after a child’s drug
death compared to other death causes: Investigating a greatly neglected bereavement
problem population. Omega—Journal of Death and Dying, 63, 291–316.
Feigelman, W., Jordan, J. R., McIntosh, J. L., & Feigelman, B. (2012). Devastating losses:
How parents cope with a child’s suicide or drug death. New York, NY: Springer.
Murphy, J. (2015). Illness or deviance: Drug courts, drug treatment and the ambiguity of
addiction. Philadelphia, PA: Temple University Press.
Murphy, S. A., Johnson, L. C., Wu, L., Fan, J. J., & Lohan, J. (2003). Bereaved parents’
outcomes 4 to 60 months after their children’s deaths by accident, suicide or homicide:
A comparative study demonstrating differences. Death Studies, 27(1), 39–61.
National Safety Council. (2017). Safety on the Road. Retrieved from www.nsc.org/learn/
pages/nsc-on-the-road.aspx.
Rudd, R. A., Aleshire, N., Zibbell, J. E., & Gladden, M. (2015, December 14). Increases
in drug and opioid overdose deaths—United States, 2000–2014. MMWR, 64, 1–5.
Templeton, L., Ford, A., McKell, J., Valentine, C., Walter, T., Velleman,
R., . . . Hollywood, J. (2016). Bereavement through substance use: Findings from an
interview study with adults in England and Scotland. Addiction Research & Theory, 24,
341–354.
Templeton, L., Valentine, C., McKell, J., Ford, A., Velleman, R., Walter,
T., . . . Hollywood, J. (2017). Bereavement following a fatal overdose: The experiences
of adults in England and Scotland. Drugs: Education, Prevention & Policy, 24, 58–66.
Valentine, C. (Ed.). (2018). Families bereaved by alcohol or drugs: Research on experiences,
coping and support. London, England: Routledge.
Valentine, C., Bauld, L., & Walter, T. (2016). Bereavement following substance misuse:
A disenfranchised grief. Omega—Journal of Death and Dying, 72, 283–301.

Author Biographies
William Feigelman, PhD, is an emeritus professor of Sociology at Nassau
Community College (Garden City, New York). He is an author and coauthor
of seven books and more than 60 journal articles. He has written on a wide
variety of social science subjects including: child adoptions, youth alcohol and
drug abuse, problem gambling, tobacco use and cessation, and inter-group
Feigelman et al. 19

relations. Since 2002, after his son Jesse’s suicide, Feigelman has focused his
professional writings on youth suicide and drug deaths and traumatic loss
bereavement, appearing in suicidology and bereavement journals. A member
of the American Association of Suicidology and the Association for Death
Education and Counseling, Feigelman is a frequent presenter at national and
international conferences and facilitator of a survivors’ support group. His most
recent co-authored book is entitled Devastating Losses: How Parents Cope With
a Child’s Death by Suicide or Drugs (NY: Springer Publishing Co., 2012).

Beverly Feigelman, LCSW, is a retired adjunct professor of Social Work at

Adelphi University (Garden City, New York), former Director of the
Manhasset Community Day Center of Long Island Jewish Medical Center
and former Assistant Director of the Adelphi University School of Social
Work, Field Education Department. She currently maintains a private psy-
chotherapy practice in Queens, providing family and individual counseling.
Ms. Feigelman is a member of various suicide prevention organizations, includ-
ing the American Foundation for Suicide Prevention, the American Association
of Suicidology and a co-facilitator of a survivors’ support group (LISOS.org).
She is an author or co-author of the Devastating Losses book, several articles on
suicide bereavement, addiction treatment and social work education and often
presents on these topics at professional conferences.

Lillian M. Range, PhD, is a professor of Psychology at Our Lady of Holy Cross

College, and professor emerita of The University of Southern Mississippi. Her
research is in suicide prevention and health promotion. Current professional
responsibilities: Associate Editor of Death Studies, Editorial board member of
Journal of Loss and Trauma, and Suicide and Life-Threatening Behavior. Past
professional responsibilities: past president of the Southeastern Psychological
Association, past president of the Mississippi Psychological Association, and
past member of the Mississippi Board of Psychological Examiners. She is
licensed in psychology (clinical) in Louisiana; a fellow of the American
Psychological Association through Divisions 12 (Society of Clinical
Psychology) and 35 (Society for the Psychology of Women); and, a member
of the Louisiana Psychological Association and the American Association of
Suicidology.