Background
In 2013 I authored an article, A Different Kind of Grief©, for the MCDES September newsletter. Sharon Dardis recently asked me if I would write another equating where things are now with substance use related deaths compared to where they were in 2013. As an advocate in addiction -recovery my initial jaded response to Sharon’s request was that not nearly enough has changed for those seeking recovery services as well as for their loved ones. After contemplating this further, I’d have to say the biggest change in the last nine years is increased awareness of addiction related deaths. This unfortunate “gift” arrived with the opioid epidemic which was just beginning to raise its ugly head in 2013.
Special Support for Group Members
My previous article focused on why/how I discovered the need for specific grief support for those who have loved ones who have died from addiction related causes. This need hasn’t changed, but the numbers of loved ones needing this support has exploded as have the deaths of their loved ones. To my knowledge in 2013 Recovering u was the only organization offering this specific grief support. Now there are more ongoing weekly or monthly groups (See my resources at the end of this article). These differ from our consecutive six-week groups because each week we offer an educational component relating basic understandings of substance use disorder (SUD), the disenfranchised nature of their grief and the interplay of trauma that occurred both while their loved one was alive and how it follows them in their grief and mourning. The stigma and shame that still accompanies SUD sometimes keeps our group members ignorant about the nature of SUD while their loved is alive. They may not even be aware that their loved one suffered from a SUD until they died. Healing begins when they let go of the stigmatized ideas connected to SUD. Primarily, they need to understand that neither their loved one nor they have the power to rid their loved one of this disease alone. When they let go of the “why did my loved one die” and accept the “what” – that their loved one died from a brain disorder for which there is no cure, only recovery, real healing begins. Until they understand and accept their loved one died from an illness they couldn’t cure, control, nor cause, they can’t move into their processing their own grief.
Recent Statistics for Deaths Related to SUD
How have the deaths of those suffering from SUD changed over the last several years?
- Overdose deaths reached almost one million in the United States from 1999 through 2020, according to a new study by the Centers for Disease Control and Prevention (CDC).[1]
- A study in 2019 by the National Institute on Aging examined the falling US life expectancy using data from the CDC, National Center for Health statistics and the U.S. Mortality Database. The study found that following 2014 life expectancy began declining with “A major contributor… has been an increase in mortality from … e.g., drug overdoses, suicides, organ system diseases among young and middle-aged adults of all racial groups…” 2
The COVID-19 pandemic proved devastating for all people with substance use disorders. Before the pandemic began the overdose epidemic was finally getting its reckoning. Purdue Pharma was being sued in state and federal courts for their unconscionable contribution to the over prescribing of prescription opioids. Books and movies about methamphetamine and heroin addiction, like “Beautiful Boy” and Netflix’s Emmy award winning series, “Dope Sick” were being read and viewed by the general public. Then Covid hit. All of the things that had begun to bring the opioid epidemic into the light of everyday were buried under the pandemic’s statistics and deaths.
- The latest data from the U.S. Centers for Disease Control finds that between May 2020 and April 2021 there were 100,000 drug overdose deaths in the country. This is a 30% increase from 2019. Sixty-four percent of these overdose deaths were tied to illicitly manufactured fentanyl or its chemical cousins. These overdoses are killing the young: About 1 in 5 fentanyl-related deaths now involve males under 25 years of age.
- The pandemic disproportionately affected drug overdoses for people of color. According to the CDC researchers found that overdose deaths jumped 49% among Black people in the United States from 2019 to 2020, compared with a 26% spike among white people3.
- American’s love affair with its long-time legal drug, alcohol, saw an increase in consumption during the pandemic. Women most often bore the brunt of holding down a job, supervising online learning for their children along with household duties. Their drinking episodes increased by 41%4. Alcohol use increased by 19% among all adults aged 30 to 59.5 How interesting the liquor stores were considered an essential business during the pandemic.
- Overall, Native Americans struggle with higher rates of drug abuse, overdose, and dependence than the general population,6. “This new finding flies in the face of public perception and really makes it clear that as we address the overdose crisis in the United States, we have to think of it as a racial justice issue, along with a social justice issue, because low-income people are disproportionately affected including white Americans,” said senior researcher Dr. Helena Hansen, a professor of psychiatry at UCLA David Geffen School of Medicine.
Isolation and Substance Use Disorder
COVID disrupted all aspects of society but the isolation it created posed unique risks to individuals with SUD. Although recovery from any addiction is possible, the isolation created by the pandemic was doubly troubling for those with a substance use disorder. First, the safety guidelines of the pandemic initially prevented people from attending in-person recovery groups. Newly recovering people often do not have the financial ability to own a smart phone or computer so they couldn’t even log into an online recovery meeting when they finally became available. Second: treatment centers shut down for a period of time. The lack of connection to recovery meetings and treatment centers proved devastating for the newly recovering person and those seeking recovery. Although there are numerous pathways of recovery, sharing one’s recovery with others is how and why recovery happens. People seldom recover in isolation.
Change in Our Grief Group Population
I’d also like comment on the ebb and flow of the nature of the deaths our group members experience over the last ten years. Initially and up to the Covid-19 pandemic most of our group members loved ones had died from opioids or a combination of opioids and other narcotics. The group members were mostly parents whose children had died. This makeup grew quickly when fentanyl came on the scene.
Specific Sibling Interest
About three years ago we began to receive interest from siblings mostly wanting a ‘siblings only” group. They found that when their brothers or sisters died, their grief was often deferred to the parents or even grandparents. They and their grief almost became invisible. I did notice that if we had a sibling in group along with parents, the sibling (even though they were not related) often acceded to the parents and the parents often coddled the siblings. I had one sibling repeat my group. After being in a group with parents she joined a “sibling only” group and was noticeably freer expressing her views and feelings. She said that after completing the “sibling only” group she finally felt safe in her grief and mourning journey.
A ”Men Only” Group
In the fall of 2021, I also received a request from a few men to have a “men’s only” group. Although there are differing views about/if men and women grieve differently, we decided to honor this request. My husband who had been in a mixed (both men and women) Alanon group and a men’s only Alanon group definitely believes men express their feeling more freely in a group when in the presence of men only. Since he had group experience and training in group facilitation, he agreed to facilitate the group. During some of the sessions I would offer the educational piece, then leave, and he would facilitate the reflection and group check-in. The men that participated seemed incredibly pleased and went on to be part of our monthly group we offer for those who have been through the six-week group.
My Personal Wake-up
Having a child die of overdose and discovering his body after a 20-year struggle with SUD has definitely been a traumatic recovery process for me. Myself as well as my co-facilitator, whose daughter died of a poly substance overdose meet with a licensed therapist for consultation once a month. Listening to comparable stories like ours was the general make up of our groups until this last year. Ninety percent of the people who became part of our groups in 2022 have had children, spouses, siblings, and parents who died from alcohol misuse. We are often humbled by the grueling details these courageous, dear people share about how their loved ones died. Alcohol Use Disorder often allows the user to function at a fairly high level for an extended period of time. When they start to decline it often comes quickly leaving the loved one astounded as they watch their spouse, parent, sibling, or finance’ experience organ failure, internal bleeding, and dementia-like symptoms that can’t be reversed. Many of their loved ones never experienced the opportunity to receive treatment. Initially group members’ loved ones were in the later years of their life when they died. Then more of them we middle aged – in the height of their careers or still raising a family. Most recently we have had group members whose loved ones have been in their early 30’s and late 20’s. I didn’t realize that I had unconsciously considered that overdose deaths were the most traumatic until I began to hear these stories of loss and death. I share this with you not to shock or alarm you, but to help ground us all on the possible devastation of our “legal” drug. I think the statistics I shared earlier should also help bring this home.
A Needed Change in SUD Assessment in Minnesota
Awareness is always the precursor to change. With SUD hijacking the brains of those who suffer, time is always of the essence when one decides they need help and asks for it. One of the newest changes in the treatment enrollment process for publicly funded treatment improved in June of this year. The Minnesota Department of Health and Human Services ended its policy on June 30th requiring a “Rule 25” assessment as the only method for eligible people to receive publicly funded SUD treatment in Minnesota6. They now offer a direct access model. “This model allows people a choice in a provider, as well as allowing them to go directly to a provider in order to receive a ‘comprehensive assessement’”7.I cannot tell you how many times my son (as well as client’s loved ones) waited several days, even weeks just to get an assessment only to change their mind about going to treatment during the waiting period. And of course, their life was continually endangered because they were using while they waited for an assessment just to keep from going into withdrawal.
When you loved one’s life is endangered by this chronic illness the right help can never come fast enough. Let’s hope this change in the Rule 25 Assessment opens the door more quickly to those who seek and need recovery treatment support.
References
[1] Hedegaard H, Miniño AM, Spencer MR, Warner M. Drug overdose deaths in the United States, 1999–2020. NCHS Data Brief, no 428. Hyattsville, MD: National Center for Health Statistics. 2021. DOI: https://dx.doi.org/10.15620/cdc:112340external icon.
2 “The Role of Alcohol, Drugs, and Deaths of Despair in U.S.’s Falling Life Expectancy,” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144704/
3(2021). Alcohol & Substance Abuse. National Congress of American Indians (NCAI). Retrieved April 2021 from https://www.ncai.org/policy-issues/education-health-human-services/alcohol-substance-abuse
4,5Alcohol Consumption Rises Sharply During Pandemic Shutdown; Heavy Drinking by Women Rises 41% | RAND
6(October 2020). Injury Prevention in American Indian and Alaska Native Communities. Centers for Disease Control and Prevention (CDC). Retrieved April 2021 from https://www.cdc.gov/injury/tribal/index.html
7Substance Use Disorder (SUD) Services – Rule 25 Process (state.mn.us)