When someone’s loss is not openly acknowledged, socially accepted, or widely mourned, their grief can be described as “disenfranchised” [1]. Social norms dictate a range of acceptable circumstances around grief, relating to what loss occurred, how that loss occurred, and how the bereaved grieve that loss. Once someone’s behavior or the loss in question falls outside of those norms, the support offered and received often decreases. The concept of disenfranchised grief encompasses this process, emphasizing that the internal process of grieving is inevitably impacted by how peers and society at large validate that grief.

There exists a large population in the United States and beyond experiencing disenfranchised grief as a result of losing a loved one to a drug-related death (DRD). Drug overdose death rates from 2022 show that almost 108,000 people died as a direct result of drug use. Though a number is difficult to pinpoint, there exist many more people that have died of other causes tied to their drug use. Approximately 17 percent of the survey population in the 2015 National Survey on Drug Use and Health reported use of an illegal drug, use of a prescribed drug, or heavy alcohol use during the previous year. Approximately 8 percent of those surveyed, equaling over 21 million people, reported symptoms or behaviors that indicate substance use disorder.

To clarify what exactly a “substance” in this context means, consider the definition from Thomas McLellen, PhD, former Deputy Director of the Office of National Drug Control Policy. He defines a substance as “any psychoactive compound with the potential to cause health and social problems, including addiction.” Commonly known and used substances include nicotine, alcohol, cannabinoids, opioids, depressants, stimulants, and hallucinogens.

These drugs not only predispose users to a range of physical and mental ailments, but they also directly alter the brain in ways that perpetuate substance use disorder. Researchers in the medical community have increasingly recognized addiction as a chronic disease of the brain, as it inhibits information processing and communication channels. Research has shown that drug use interferes with the way nerve cells process and transmit information. Drug use also impacts the cortex, which serves as the hub for abstract thinking and cognitive processes, the limbic region, which acts as our emotional reward system, and the hippocampus, which affects our long-term memory.

The use of many addictive substances can also increase one’s risk for chronic illnesses, including heart disease, stroke, cancer, HIV/AIDS, Hepatitis B and C, and liver and lung disease. Data from the National Center for Health Statistics show that heart disease, cancer, stroke, and chronic liver disease or cirrhosis all fall within the top ten causes of death in the United States. Each of these can be triggered or worsened by substance use.

When you think of someone announcing they have lung cancer, they may or may not clarify to you that they have “never smoked a day in their life.” Why do we feel the need to say that? Is it because we know that society may sympathize less with our plight if they feel like our actions somehow contributed to the same disease?

Whether or not someone abused substances before their death has a distinct impact on if and how society offers support and if and how the bereaved ask for support. The category of self-destructive deaths, which includes both DRDs and suicide, has long been stigmatized. After a self-destructive death, society has a tendency to attribute blame to the victim as well as their close network of family and friends, though the true web of factors contributing to the death is almost never clear nor straightforward. Many grieving the loss of someone to a DRD feel like others may negatively judge their loved one or their family because of the circumstances around how their loved one lived and how they died [2] [3]. This fear of judgment is rational – in one study, both close and distant family members and peers indicates that DRDs were not worthy of grieving [2]. Media only encourages these attitudes by portraying victims of substance abuse as sleazy, dishonest, and generally unsympathetic characters.

Close family members and friends often already experience complicated emotions after their loved one’s DRD. In many cases, there exists a conflict between their love for the victim and their frustration about their self-destructive behavior [4]. The bereaved may hold conflicting emotions simultaneously. They may feel guilty about what signs they may have missed or what more they could have done to help the victim or prevent their death [5]. They may even feel a sense of relief as their family is released from the seemingly endless loop of substance abuse.

Whether or not someone’s loved one passed as a result of substance abuse does not dictate whether they deserve to grieve or to have the space and support to do so. Those experiencing grief after a DRD need to have the opportunity to process their complicated emotions without judgment. Without access to a strong support network, the social isolation of grieving a DRD can prolong the grieving process and lead to persistent mental health challenges for the bereaved.

Social change starts with individual people changing their outlook and behavior. As with many other aspects of our lives, we must question where our initial reactions come from. We have to spread awareness about the reality of substance abuse in our country and the stigma that affects not only the victims of substance abuse but the families grieving a loved one’s death. The crisis of substance abuse in this country is a failure of our social and economic systems. The stigma towards and isolation of those grieving a drug-related death, however, is a failure of empathy.

[1] Doka, K. J. (1989). Disenfranchised grief: Recognizing hidden sorrow. Lexington Books.

Hochschild, A. R. (1979). Emotion work, feeling rules and social support. American Journal of Sociology, 85(3), 551–573.

[2] Dyregrov, K., & Selseng, L. B. (2022). “Nothing to mourn, He was just a drug addict” – Stigma towards people bereaved by drug-related death. Addiction Research & Theory, 30(1), 5–15. https://doi.org/10.1080/16066359.2021.191232

[3] Feigelman, W., Jordan. J., McIntosh, J., & Feigelman, B. (2012). Devastating losses: How parents cope with the death of a child to suicide or drugs. Springer Publishing Company.

[4] Worden, J. W. (2018). Grief counseling and grief therapy: A handbook for the mental health practitioner (5th ed.). Springer.

[5] Li, J., Stroebe, M., Chan, C., & Chow, A. (2014). Guilt in bereavement: A framework and conceptual review. Death Studies, 38(3), 165–171.