Episode 2 - Bereavement by Drugs or Alcohol

In this episode we explore the unique challenges that come with a bereavement by drugs or alcohol, and what we need to know when supporting a client who has experienced this kind of loss.

Transcript

 Welcome to grief in the room. In this podcast, we do a deep dive into all things grief. So that when those themes of grief and loss show up in your client's story, you're prepared with the insight, tools, and most importantly, confidence to give them the kind of support they need. Grief in the room is presented by Martin Roddis and Trudie Bamford, grief trainers and advocates and good friends.

We bring warmth, humanity, and humor to the subject. We're so glad you're joining our conversation today. Please do subscribe to and say hello to us in the comments.

 What are we doing today? Drugs and alcohol. Well, currently I'm not drinking and I know you're not drinking. So that means You're not using this. Well, I might do. This is called a cold welcome. A cold welcome. Yeah, so it's, it's not scripted, it's not formulaic, and that's, that's what you do, apparently.

All right.

You get a different look on your face when you're thinking to yourself, I'm going to use this footage.

You get a slightly, you get a slightly cheeky little boy look, twinkle. So is that the only tell you've got? Yeah. Okay, all right. You can't tell from any of the other sophistications that I bring to the table. No. All right, good. So drugs and alcohol in the framework of grief. Yeah. Yeah. Bereavement by drugs and alcohol.

This is something that you have been passionate about for a long time. And this is something that you wrote a short, uh, webinar, 60, 90 minutes for the recent cruise. Summer of Learning, as it was called, and it was, it was well attended. It was well received. And I know from when you were speaking to me that you found quite a lot of data that you drew upon, but also a lack of data and a lack of material. And it's certainly a lack of CPD,  which is what this whole podcast has been about. And I know you've got a lot of lived experience because, you know, We've spoken about it in our relationship and also when we've trained together as well.

So this is kind of your show. And if you don't mind, I would love to hear you and then tease stuff out of you. 

 certainly this is, this is a topic where I will be telling a little bit of my story, but also going into professional experience too, because I have used my lived experience to work with many people bereaved in this way. Um, And I have been kind of quietly campaigning behind the scenes to for there to be more training on this topic because there isn't there is there is growing training around bereavement by suicide, but very, very I mean, very little training available, certainly in the UK for how to work with people bereaved by drugs and alcohol.

And yet those deaths are at an all time high. So as therapists, as counselors, as supporters, as volunteers, we are going to be encountering people with this kind of bereavement more and more regularly. And these bereavements do need special handling. There is no question about that. And would it be fair to say that some of these Like a lot of others, slip through the assessment phase and stage.

Absolutely. So that when we see our clients, especially on placements, we're told that it's a hex. And then as, as normal grief and bereavement, we know that it's not just the fact that somebody's died. We know that there are many different implications about as to the intensity and amplification of that grief, nature of death, relationships.

Sudden and shocking, and, and, and. And what you found during your research, is that it's, it's, you know, it's high up there, isn't it? Absolutely. Yeah. And I think that is a really important point to make right out of the gate, is that people who are bereaved in this way are very often Not going to be up front about it because of the shame because of the stigma because of the judgment so it is Very likely that you will find yourself working with somebody who has Been bereaved because of drugs and alcohol.

They may not be telling you that So you might be bumping up against Kind of grief that feels unfamiliar to you, but you don't exactly know why that is because until you build up that trust and relationship with that person, which we know takes time in therapy, they may not feel able or comfortable. to share with you the cause of death.

So even if you don't currently have clients who are bereaved in this way, even if you think to yourself, well, I'm not sure that's something I want to work with. I really, really would encourage everybody, all counselors, all therapists, all volunteers, all supporters of any description to understand this topic because you're going to encounter it.

Whether you plan to or not, you're going to. People meet me. I can promise you that I am one of the last people you would expect to have in their story losing a brother to heroin. and losing a sister to alcohol. I am not the, I'm not the, uh, stereotypical person you would expect that of. You are going to be encountering people all the time who have this in their history in one shape or form.

So it's really important to, to be able to understand the very distinctive aspects that they will be dealing with when it comes to their grief. So, to that point then. And we do know and we do talk about, you know, the unique characteristics of certain natures of death and then the, the effects and the, the different doorways that we can go through, you know, uh, murder, suicide, drugs and alcohol.

You know, there are some, it's all grief, of course, but there are some unique characteristics. How do you want to go about unpacking some of the unique characteristics of death? Drugs and alcohol, and you've mentioned the amplification of guilt, shame, judgment. Where would you like to start? With that, I think, because that is probably the biggest, the biggest thing.

Um, and is the reason why people may not be up front with you. I think it might be helpful if I kind of briefly go back to, which I think we've touched on in the previous episode, but where I was first trained with Cruz was with the understanding your bereavement online team, which you trained before  the peer to peer support, and psychoeducation, workshops that Cruz run.

And, I noticed very, very quickly, because we, we would ask on that beforehand, what the cause of death was so I could see when I was a facilitator for one of those sessions, I could see the people in there that had lost people to drugs and alcohol. It was always some. And I noticed very, very quickly the pattern there was that they would come, they would stay for the whole session, but they would almost inevitably not talk.

In the breakout rooms with the peers, they would not talk, they would stay and listen, but they wouldn't share anything about their grief, their loss, the details, nothing. And you correlated that, you, you actually, you actually observed that. Because obviously as facilitators, we know what their unique bereavement was, but we never bring that out, we allow them to lead or speak or not speak.

So you could actually, you started to see And, and correlate that particular loss and a lack of communication. Yeah. 

And one, one particular, uh, episode, I can't remember what they're called. Um, I was the, I was the lead on that. So the lead would stay in the main room and hold that main room while everybody was off in their breakout room.

So that if anyone comes out of the breakout room upset, there was somebody there. I was sitting there just. Quietly waiting and somebody came crashing out of the breakout room, huge amounts of distress. And it was one of these people who'd been bereaved by drugs in this case. And she was deeply agitated and distressed.

Um, she said she wanted to talk in there, but she, everybody had lost parents to cancer and heart attacks. And she couldn't say what had happened to her. She felt shame. She felt fury. with the person that she'd lost for what they'd done. And she was incredibly distressed 

which kind of confirmed, you know, what I'd already been thinking, which is that they need specialist support because it is so, so difficult to talk about your bereavement alongside other people who may have experienced You might call a normal bereavement, you know, in society, we have this concept of a good death and a bad death and death by drugs and alcohol is absolutely considered to be a bad death.

Even though there is a little bit more understanding now when it comes to substance misuse, nevertheless, people who, uh, are engaged in substance misuse are still perceived by society to be Bad people. Mm hmm. And so when one of these deaths happen, that death is very much stigmatized and the people left behind are left carrying.

That stigma, that shame, that anger, along with their grief, yeah, absolutely. So their grief can then be disenfranchised even more so and amplified. Very much so, 

and especially I think this is the case for drug misuse, you know, I reflect on, um, my own brother's story, he was a heroin user for about 18 years before he died.

They become dehumanized. They're just a junkie. And when they die, well, it's just another junkie. They brought it on themselves. This is the judgment that society puts on them. This is what people who are left behind are dealing with. That they're not only dealing with the grief and the loss, but knowing that from that point on, pretty much all that anybody's going to remember of that person that they loved is is the way they died.

You know, we know that that is the case for suicide deaths as well, but there is to some extent a little bit more compassion in society when it comes to suicide. There is very little compassion when it comes to substance misuse, because people think, well, you brought that on yourself. 

so, in a relationship, so, let's think about the person that's died from drugs and alcohol is in a, you know, it's a first degree relationship, so it's a partner, it's a child, it's a mother, it's a father. And they're holding this shame and guilt and grief, 

 and then they come to speak to someone like us. What kind of approach, you said it requires a specialist kind of support. How do you see that in your experience and your eye, that specialist kind of approach unfolding? Do you have a strategy? First of all, it's really important to realize we don't put timeframes on grief and we don't put timeframes on grief support, but it is inevitable that these kinds of, these kinds of bereavements are going, you're going to have to show a lot more patience.

A lot more patience is going to take people a lot longer, both to unpack with you what has happened and to work through some of the grieving processes. You know, we

 support people as they engage in meaning making, we support them as they work through continuing bonds so that they can carry that person with them.

These are not going to be easy processes for anyone grieving, but they are going to be significantly harder for somebody who's been bereaved by drugs and alcohol. 

Because of the nature of the death, and because, not in all cases, but in many cases, This is the end result of a long, long, long time of struggle.

All of that's got to be processed too. It's not just a case of processing a sudden traumatic death. It's the processing of what went before that. 

So if you're a parent. Yeah, who's lost a child to drugs and alcohol Particularly if it is as the result of a long struggle with drugs or alcohol Yeah, it is likely that you're going to be looking back on your parenting Yes.

You know what, at what point, what did I do wrong? Should I have been stricter with them when they were a toddler? Did I give them the wrong foods? Did I give them too much sugar which, which made them more prone to addiction? Should I have been stricter with them as a teenager? Should I have spent more time with them?

So it's not just dealing with devastating grief and guilt. Yeah. But it's also that looking inward and thinking, what did I do? And this is actually part of the process of meaning making. We do know this, it's all part of trying to make sense of it, but it can be such a difficult process for somebody and they do need support.

As they, as they unpick that, and they will probably go round and round and round and round and round with the same questions. They do need support in that. 

And we're, we're, we're talking rumination here, aren't we? I mean, all that counterfactual thinking as well, and rumination.

And we know that mindless grief rumination, Is a definite indicator for prolonged grief disorder Um and a therapist can help with that cognitive restructuring In terms of that rumination to you know, and there's lots of different ways. We're not going to go into that now 

 but primarily the role of the therapist is going to be giving them a safe place.

To talk and articulate those cognitions. A safe place and a place that is there for as long as it needs to be there. You know, we don't, in grief work, we don't try to hurry people on. People will get to each part of the process as they get to it. But I think sometimes within ourselves as therapists, we can get impatient because it's coming from a place of caring.

You know, it's really hard to see somebody in distress. And we want, you know, we want them to find meaning, we want them to find a way to have the continuing bond. We want them to start to, to come through. But that takes time. It takes time and it's going to take longer than you imagine. when it's this kind of bereavement.

Because we may be talking years and years of loss, this is, this is another really important point to come to. They won't just be grieving the death loss. If it is as a result of substance misuse over time, they lost that person a long time before they died. I lost my brother decades before he died because he just became about heroin.

There were, you know, There was no, there was no kind of person there to access anymore because it was all just about the drugs 



so that loss, That loss has to be processed and the anger that that can bring to, you know, we've talked a little bit about, about what it's like as a parent.

I can speak to what it's like as a sibling. You do carry, well, I won't generalize, a lot of us as siblings will carry a lot of anger over what had happened over the years, and after the death, siblings bereaved in this way, they're sometimes called silent mourners, because all of the, Understandably, all of the focus is on the parents who've lost a child.

Understandably. But those siblings have lost somebody too. They are supporting the parents. And if the parents had spent a long time focusing on the child that was struggling, they've lost, those siblings have lost parental care. attention, parental care, parental focus. So that all has to be processed too.

So you've lost, you've lost not only your, your sibling relationship, which can be beautiful or not. I get that, generalizing again, but also if drugs and alcohol were in the house. I'm being used that as you've said is accompanied by lots of other things, you know, to feed that habit can be incredibly destructive on the family, on the sibling, on everything is things disappear, things are sold, mixing with the wrong people, which may, you know, start to infringe on your world as well.

So, I mean, there's so much. To be unpacked over the years, isn't there? Yeah. And after the death, we know just after any death, each person in the family is going to react differently. Each person is going to process it differently. And that can be even more amplified after one of these kinds of bereavements.

So maybe some in the family will do anything to kind of whitewash the memory of the person. Because understandably, they don't want that to be all that's remembered of them. Others in the family, you know, who are dealing with a lot of anger, perhaps, may really resent that. really resent it. And so the family system, and you know, a lot of the, a lot of our listeners will be familiar with family systems, the family system, which has already been significantly impacted perhaps by substance misuse will be even more impacted after the death.

So again, this is all going to take time. It's all going to take time to process and unpack and stabilize again. And find ways to perhaps rebuild relationships that may have become severed or damaged by what has happened. So, for example, a lot of the placements, and I know in your placement you deal with a lot of this because of the nature of your placement as well.

In terms of, and again, a different type of placement that you do as well, gives you more time because they recognise traumatic bereavement. Placements or therapists may only get a certain limited number of sessions to be able to help someone with this. So what kind of strategies would you suggest, or what kind of, obviously the therapeutic working alliance has to be established for that trust to be built, but then it sounds like that this is more specialist work and it sounds like it is going to take more time.

So is there a couple of. Tips hints resources that you can suggest that that may help if time runs out if the clock just finishes What can you get in there, you know? Well, what I would say first is if you are aware that your client has got history that Relates to bereavement by drugs and alcohol right from the very beginning.

You need to set the stage within yourself To, to, first of all, acknowledge any inner judgments that you may have, and that's okay. You know, we're fallible human beings, we try to be non judgmental, but we aren't. So first of all, just kind of just taking a moment and thinking, how do I feel about this? What are my, what are my, um, moral judgments about this?

Now, can I bracket those? Kind of bracket those to be there for my client. Um, try from the very outset, if you possibly can, to, to build that strong therapeutic relationship if you know that your time is limited. Sure. Mirror the way that they talk about the death and the way they talk about the person.

Our, the language that we use is so important. Some people find terms around addiction, Very stigmatizing. So be very conscious that you are mirroring the way that they speak. If at all possible, use the name of the person who died. We know that's important anyway, but it's even more important here. So rather than saying your son.

Use the name because it humanizes that person again and it makes them real and it brings them into the room with you. And what your goal is in supporting the person, it's to allow them to experience that person again in all aspects. The good, the bad, the tragic, the funny, the beautiful, the brave, the cowardly, every single facet of that person.

If that can come into the room. And they can, they can make some sense of peace. This is where continuing bonds can start to be forged. So by us creating that, by us trying to help them to experience that person and that relationship in all aspects of it, good and bad. You know, there is always going to be a sense of unfinished business with any sudden traumatic loss, and especially with this kind of loss.

We can support our clients in exploring that unfinished business in the room with us. And I've done this, and it works. It really does work. And yes, you may only have a limited number of sessions. You can go some way though. Towards helping them to do that. And then you may well need to signpost them on, you know, standard.

Generally people only get succession. Sometimes that can be extended if it's a traumatic loss or if there's other, you know, factors that can be taken into consideration, but if you really cannot extend, then I would strongly suggest signposting on, um, there are organizations Adfam, which I suspect has now renamed itself, so we might need to look into that, that do have specialist support groups and, and specially trained counsellors, therapists, qualified ones who understand this kind of bereavement and can support.

So look into that. Yeah. There is also, um, a book that has been published by. Peter Cartwright. I'm not going to get the title exactly right, but that is his name, Peter Cartwright. And it's something like supporting people after a bereavement by drugs and alcohol. He also does some basic training in this as well, but that book is excellent and it's very comprehensive.

And he's, you know, he's a lovely personable. really helpful guy. So by all means, reach out to him as well. So group support and community sounds really, really strong. Yeah. And I think that's really important because that goes some way to offsetting the stigma and the isolation that will come after these kinds of deaths.

And You know, there's other aspects that we haven't really touched on today that only somebody who's been bereaved in this way will get, such as having to deal with the media intrusion, having to deal with the public nature of the inquest, and that can be very insensitively handled. Um, feelings of resentment that people may have over treatment by professionals, such as paramedics or coroners, whether that's right or not.

Is, is not relevant. They feel that way. Perhaps they feel that the person, they didn't make much effort to revive them or something like that. You know, it's not our place to say whether that actually happened or not. That is their truth. That's how they feel. So being able to unpack that with other people who understand, who get it, who have their own lived experience, that can help to start to reconnect people again.

Now, these podcasts or pods, as I like calling them, are not scripted. We do not script them. And, and certainly 

 this one is really free flowing and I'd like to just touch on something in terms of what you just mentioned about therapists having lived experience.

So in terms of your lived experience, Trudy, and I don't know if you've mentioned Martin's name. Did you mention Martin's name? Your brother? No. No. Okay. In terms of transference and counter transference, is there anything that you particularly want Mention or you've reflected on personally? 

Like many of us who have dealt with this I am extremely good at compartmentalizing it And you know As you've just picked up, I don't generally mention my brother and sister's name and I think that is part of, of how I handle that. I'm able to talk about it from a kind of a detached viewpoint. Yeah. And I need to do that as well.

When I am supporting somebody bereaved in this way, because, because of transference, counter transference, I need to kind of find a way to bracket my experience, but also to use it to understand, um, I don't think I've really answered your question. I think you have, I think you have, you answered it very, very nicely.

And I know you've mentioned. Your brother's name in a LinkedIn post that you wrote not so long ago as well. Um, and I know also that when I've been training with you, there have been varying degrees of disclosure that you've made throughout the different courses. And sometimes you and you've not had the resilience and you've taken a backseat because we work closely together as well.

And I know that you could say something, but then you do not. And so I know how that works as well with, with yourself. It's a tricky one when you're with a client, because. You know, we know that self disclosure can be useful. It can be powerful, but it can also be dangerous and it has to be really wisely implemented.

And there have been times with clients where I have desperately wanted to say. I know I've lived this. I get it. I promise you, I get it, but it has felt, 

inappropriate. There have been other times where I have. slightly disclosed something 



and I had a really interesting conversation about this with my crew supervisor on the Traumatic Bereavement Team.

Because I was in this one particular case, I was really, really struggling with this desire to say, you know what, I know what this is like, because it was, it was a heroin overdose death. And he said to me, you can frame it in the right words. So you can say this isn't about me, but I do have some experience in this area.

You don't need to say lived experience because then they know it's about you. But if you say I have some experience in this area, well, that's up to them to kind of, you know, that could just be with working with clients or it could be your own lived experience. It's up to them how they, you know, take those words.

I think sometimes it is necessary. in order to connect with somebody. I think it is, it is necessary, but yeah, we do need to be extremely careful that we're not making it about us and that it is in the service of the client, 

and, and I think my gut in this particular case, my gut was telling me that it was actually more in my service than it would have been in hers.

It wouldn't have, I wouldn't have actually helped her. It would have helped me. So I didn't. 





So Trudy, can we prioritize some form of, uh, CPD, 

 it absolutely blows my mind that there isn't any There isn't any real training on this topic.

Okay. I, and I, I can't help but make the link between the stigma and the lack of training. I think, you know, we've done a huge amount of work over the last few decades to de stigmatize suicide. And as a result, It is now being spoken of more. There is now much more training available for people working with bereavement by suicide.

And I think the same needs to be done on this topic. It is a topic where people are like, Ooh, don't want to go there. You are going to face it. You have to go there. So yes, as you can tell, this is something I am deeply passionate about. And we are certainly, uh, in the process of creating. The CPD that is desperately needed, that we are both asked for all the time.

Because it is out there and there is only one book written on it, which I've mentioned one book One book and yeah, it is such a specialist subject and one that we will inevitably face So basically watch this space Absolutely.

 Thank you for joining our conversation today. This episode of grief in the room was presented by Martin Rodis and Trudy Bamford. Join us next time when we'll be talking about. So today we are going to be talking about the grieving brain, and that's based upon the research of Mary Frances O'Connor, who is one of the world's leading griefy Is that a word?

Neuroscientists, a professor of psychology at the University of Arizona where she directs the grief, loss, and social stress, which is the Glass Lab. So if what we offer you today, and that's all we're going to do, we're going to offer you our insights and how we're relating to it in our training experience and our supporting experience of the bereaved.

When it comes to training, I feel like, I mean, we share a huge amount of material with people when we're training, don't we? But it feels like the grieving brain is the big hitter. It is inevitably the thing that at the end of the training session, people say, that's the thing I'm taking away with me.

That's the light bulb moment. Um, because it, it, It is really just it is that unifying model as you said it is it's that unifying theory rather And it just gives people permission to grieve And to be patient and to know that there is there is rewiring going on. They're not stuck It just excites so the grieving brain Science love loss.

Those are the things we're covering to begin with and then we'll kind of dig into that more It's redefined how I teach grief to, and it's, it's, it's redefined how I frame grief. And it literally has gone from that to that, to that, to this. It's redefined how I frame grief to people that are grieving and also that are helping grievers.

So both my educational role and my therapist role has changed. And it's a path for the good and it's a start and it's going to help give insights into prolonged grief disorder and the, the, the true effects of nature of grief.