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.
Aims The objective of this study is to contribute to an improvement of bereavement services and experiences for the bereaved after drug-related deaths (DRDs) by investigating their expressed opinions on what would constitute improvements. Methods As part of a larger survey questionnaire, we asked people bereaved by DRDs what advice they would give to politicians to improve bereavement services. Out of 255 respondents, we received 196 written statements of advice, 83 focusing on the time after death. Two-thirds of these respondents were either parents or siblings, the other third were other family members or close friends. A thematic analysis was conducted to examine the written statements. Results We found four central themes: broad-spectrum help, routinised help, respectful help and competent help. The advice represents a long list of psychosocial support to ideally be offered on a regular and long-term basis. Furthermore, the bereaved also discussed the cognitive and normative side of the services by including considerations about stigma and respect, and the need for more research- and experience-based knowledge about their experiences both before and after DRDs. Conclusions Many of the services sought by the bereaved are already in place and described in national guidelines for follow-up strategies after sudden unexpected deaths. DRDs, however, has not been included as a task for the services and are not explicitly mentioned in these guidelines. The scope of research and policymaking on drug problems and DRDs should be broadened to include families and social networks in order to make the group more visible and strengthen their influence on policy.
Background and aims: Drug-related death (DRD) is a major public health concern in the Nordic countries, in the rest of Europe and in the US. After a DRD, approximately 10–15 next of kin will be left behind. People bereaved after sudden and unexpected deaths have a documented higher risk of reduced quality of life, daily functioning, and early death. It is important to know the resources professional helpers have available to them, the barriers and possibilities they face in their work, and how they can respond to the needs of the bereaved. This knowledge can help prevent severe health and social consequences of bereavement following a DRD. In this systematic review, the aim was to explore knowledge regarding professional helpers’ experiences of providing assistance to people bereaved after a DRD. Methods: Inclusion criteria were empirical studies of professional helpers’ first-person perspectives on meeting the bereaved after a DRD. Quantitative, qualitative, and mixed-method studies were included. Results: The results show that there are no studies addressing professional helpers’ experiences of providing assistance to the bereaved after a DRD. Conclusion: There is a vital need to develop more knowledge of professional helpers’ perspectives. This knowledge is important not only to improve education and the quality of health and social services, but also to help raise awareness of the bereaved after a DRD.
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.
Til tross for betydelige tiltak for å redusere narkotikarelaterte dødsfall (NRdød) så er NRdød fortsatt et omfattende internasjonalt folkehelseproblem. Vi har lite kunnskap om hvordan det oppleves å miste et barn ved NRdød. Likevel vet vi at tap av et barn gir økt sjanse for sorgkomplikasjoner, og at foreldre etter unaturlige dødsfall (som NRdød), har større risiko for å utvikle forlenget sorglidelse. Det er derfor behov for fokus på og kunnskap om situasjonen til etterlatte foreldre ved NRdød. Posteren oppsummerer resultatene fra et doktorgradsprosjekt om etterlatte foreldre ved NRdød. Doktorgradsprosjektet ble utført i perioden 2018 til 2021 ved Institutt for velferd og deltaking, Høgskulen på Vestlandet. Prosjektet studerer sorg og sorgbearbeiding. Et sosiologisk perspektiv ligger til grunn for utforskning, analysering og tolkning, mens et psykologiske perspektiv danner et viktig bakteppe. Forskningen plasserer seg innenfor feltene sorg-, velferds- og narkotikaforskning.
Background Although mortality attributed to illicit drugs is a significant contributor to the overall number of deaths worldwide, knowledge relating to the consequences for those bereaved by drug-related deaths (DRDs) is scarce. Since individuals with substance use disorders are prone to stigma, there is an urgent need for knowledge about the occurrence and content of stigmatization of those bereaved by DRDs. Method A mixed methods approach was used. In total, 255 participants (parents, siblings, children, partners, other family members and close friends) who had lost a person to a DRD were recruited. Thematic and descriptive analyses were undertaken on data derived from open-ended and standardized questions from a large survey exploring systematically the contents of interpersonal communication experienced by participants following their bereavement. Result Nearly half of the respondents reported experiencing derogatory remarks from close/extended family and friends, work colleagues, neighbors, media/social media and professionals. The main themes were dehumanizing labeling, unspoken and implicit stigma, blaming of the deceased and that death was the only and the best outcome. The remarks were negative and powerful despite being directed at people in crisis and originating from individuals close to the bereaved participants. Conclusion Individuals bereaved by DRDs experience harsh and stigmatizing communications reflecting the existing societal stigma toward drug users. This contributes to the marginalization of grieving individuals at a time when they may require support. Making people aware that stigma occurs, why it happens and how it is transmitted in society can help reduce it and its adverse consequences.
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.
Knowledge about how bereaved persons grieve can enhance quality in providing the support and potential services that they need. We aimed to identify ways in which drug-death-bereaved Norwegian parents go on with their lives and what inhibits or promotes adaptation during their grieving. Reflexive thematic analysis was used to analyze 14 semistructured in-depth interviews. We generated three themes: (I) processing grief emotions, (II) proactive coping, and (III) giving and receiving support and assistance. Processing guilt rumination, reflections on blame and a burden of grief emotions characterized grieving early on. Using cognitive strategies and functional-support-giving were found to be the most frequently used strategies. Oscillation between processing stressors and reorientation to the world promoted adjustment to ongoing life. We discuss characteristics of parents who struggle to reorient and outline important implications for policy and practice.
Background: Drug-death bereavement is an understudied topic. We explore what bereaved parents experience after losing their child to drug use. The aim of the paper is to provide knowledge about what drug-death bereaved parents go through and study the kinds of help and support they receive. Method: Reflexive thematic analysis is used to analyze 14 semi-structured in-depth interviews with Norwegian parents. Results: We generated four main themes: (I) ‘constant preparedness’ describes the burdensome overload that the parents experienced before death; (II) ‘stigmatization’ represents public and self-induced stigma; (III) ‘emotional overload’ refers to the parents’ complex and ambivalent emotions, such as anger, guilt and shock after the loss; and (IV) ‘complex relations’ describes the parents’ relations with public services and their personal social networks. Discussion: We discuss how overload, before and after the loss experience, causes a special grief. How this overload, silence from helpers, self-stigma and complicated interactions with social networks contribute to the grief of these parents is also discussed. Potential implications for policy and practice are subsequently outlined.
Artikkelen belyser hvordan etterlatte ved narkotikarelaterte dødsfall opplever møtet med hjelpeapparatet, og hvordan fagfolk som møter de etterlatte, kan bidra til å øke eller minske den opplevde stigmatiseringen av dem. Bakgrunnen for artikkelener at det hvert år dør ca. 300 mennesker av overdoser og narkotikarelatert død i Norge. Bak tallene sitter mange sørgende etterlatte tilbake. Likevel mangler det generaliserbar kunnskap om hvilke konsekvenser narkotikarelatert død har for nære etterlatte, og hvordan de møtes av hjelpeapparatet. Studier fra andre former for unaturlig død viser at etterlatte ofte ikke får den hjelpen de trenger, dersom ikke hjelpeapparatet har en proaktiv og empatisk tilnærming til de rammede. Artikkelforfatterne er knyttet til prosjektet «Etterlatte ved narkotikarelatert død i et recoveryperspektiv» (END-prosjektet) ved Høgskulen på Vestlandet. Artikkelen er teoretisk med empiriske eksempler som bygger på forfatternes egenopplevelser som etterlatte, og klinisk arbeidserfaring. Erfaringene knyttes til teori om stigmatisering, sosial interaksjonisme og kommunikasjonsteori for å belyse hvordan samhandlingen kan fortone seg, sett fra et etterlattperspektiv. Artikkelen viser at stigmatisering kan prege samhandling og kommunikasjon mellom etterlatte ved narkotikarelatert død og ansatte i hjelpeapparatet, og kan legge stein til byrden for de etterlatte. Det er viktig med kunnskap om komplekse stigmatiseringsprosesser i hjelpeapparatet.
Background: In most European countries and in the US, there has been a negative trend with increasing incident rates of drug related deaths (DRD) during the last decade. In 2017, the mortality rate due to overdoses reached epidemic proportions in the United States; i.e. the age-adjusted rate of drug overdoses reached 21.7 per 100,000, being 9.6% higher than the 2016 rate. Increasing, still lower, rates are seen in European countries. Behind these figures are many bereaved persons left behind in quiet grief. Results: Research has shown that other kinds of unnatural deaths (e.g. resulting from accident, suicide, homicide) in particular, can lead to intense suffering and reduce quality of life for those left behind. Still, drug death bereaved persons seem to be an understudied, stigmatized and invisible social group. In this paper, we review previous research and deal with strain and stigmatization before drug related deaths and The Special Grief after such deaths. Discussion: We will discuss the possibility of different grief reactions as anticipated-, disenfranchized- and Prolonged Grief Disorder among family members and close friends. Furthermore, we focus on how the phenomenology of grief is connected to contextual and personal relations and interpersonal processes. Finally, we discuss the usefulness of a relational dialectics’ perspective and a family perspective for understanding and relating to The Special Grief.
Despite high rates of drug-related deaths (DRDs), drug-related bereavement has been sparsely investigated. A systematic literature search for qualitative and quantitative studies was conducted. Studies on bereaved DRD family members and systems influencing bereavement were eligible for inclusion. Eight studies were included. Three themes emerged from the thematic analysis (Emotional Roller Coaster, Lack of Understanding by the Social World, and Meaning Making) describing an emotional and existential overload, stigmatization and lack of understanding and help from support systems. The results also shed light on life after the loss. Directions for further research were subsequently outlined.
Hvordan lever efterladte videre efter en pårørendes stofrelaterede død? I 2016 døde henholdsvis 282 og 277 mennesker i stofrelaterede dødsfald i Norge og Danmark (1, 2). Høje tal ses også i andre skandinaviske lande og i store dele af den vestlige verden. Det er nødvendigt og vigtigt at få antallet af dødsfald ned. Men samtidig må vi også have fokus på og forskning om naere efterladte, som står tilbage, når stofdøden indtraeffer.
Hvert år dør det ca. 300 mennesker av overdoser og narkotikarelatert død (NRdød) i Norge. De øvrige skandinaviske landene har en sammenlignbar forekomst. Tall fra Sundhedsstyrelsen i Danmark (2017) viser en stigning i antall narkotikarelaterte dødsfall fra 245 i 2015 til 277 i 2016. Dette er en negativ trend som også sees i de fleste land i Europa. Bak disse tallene står det mange sørgende etterlatte tilbake i en stille sorg. Tross fagfolks økende interesse for sorgområdet (Dyregrov, Dyregrov & Kristensen, 2014; Guldin et al., 2017) har sorgen ved NRdød hatt et svært begrenset fokus. I denne artikkelen vil vi omtale sorgen hos nærstående som mister noen ved overdoser eller annen død relatert til bruk av narkotiske stoffer. Sorgen ses i lys av dagens kunnskap om hva som bidrar til kompliserte sorgformer og hvordan de oppstår og utvikler seg.
Drug Death Related Bereavement and Recovery (The END-project) is a nationwide research project established at Faculty for Health and Social studies (FHS), Western Norway University of Applied Sciences (HVL). In Norway, 282 people died of drug-related deaths in 2016. In average, 264 people die by overdose annually, which puts Norway among the highest recorded instances of deaths triggered by narcotic drugs in Europe (Norwegian Institute of Public Health, 2018). Both the National Overdose Strategy 2014-2017 (2014, p. 7) and the Action plan for substance abuse field 2016-2020 (2015, p. 47) point out the need for measures to improve relief services for survivors after drug-related death. However, there is little research investigating the bereaved experiences, and which assistance and support they receive in relation to their needs. Two small, qualitative studies have been carried out in Scandinavia on the experiences of bereavement by those left behind following deaths from overdoses (Biong, Sveipe & Ravndal, 2015; Biong & Thylstrup, 2016). Globally, there are also a very few studies tied to the situation of people who are bereaved as a result of drug-related deaths (da Silva, Noto & Formigoni, 2007; Feigelman, 2012; Guy, 2004; Valentine, 2017). The main aims of the project are: 1. To fill in the knowledge gap on bereaved after drug-related deaths to document their quality of life, psychosocial health and functioning, risk factors for illness, and preventive and health-promoting factors. By informing policy makers and health and social services in the municipalities, the project aims at improving quality of life and recovery of the bereaved, contribute to a new discourse on the impact of drug-related deaths, and contribute to the development of the health- and social services. 2. Contribute to academic qualification for the employees at FHS, HVL. There are 11 employees who participate in this research project, who publish oral and written presentations and arrange the annual END-conference. 3. Contribute to student involvement in research through bachelor and master assignments related to the part-studies, whereby employees also receive increased supervisor skills related to research. The project leader is Professor Kari Dyregrov at FHS/HVL (and the University of Bergen). The project group consists of an interdisciplinary group of 13 researchers and professionals (social scientists, psychologists, psychiatric nurses, social workers and social educators) at FHS/HVL. These individuals have a variety of backgrounds in substance abuse, family therapy and the crisis field. To increase the project’s relevance, usefulness and quality, and to bring new perspectives into the studies, four persons participate as co-researchers in the project group throughout the entire research process. These are people who have lost a loved to a drug-related death and who have lived experience of the study’s research themes. The project group works in close collaboration with Bergen municipality, Norwegian user organizations, and a large group of national and international professionals on substance abuse, stigma, trauma, grief, health and welfare services and health policy.