My oldest son Aaron died of a heroin overdose in May 2007 at age 33. He had battled addiction for more than 20 years.
The death of a child is an unfathomable loss. Losing a child to addiction carries with it a different kind of grief, often wrapped up in stigma, guilt, and shame. The reaction of others, including the healthcare providers who tried to treat the addiction, can help or hurt in healing from that grief. Let me tell you Aaron’s story.
Aaron’s first exposure to drugs happened shortly after he was 11 years old, when he experienced an accidental “high” after inhaling gasoline fumes while filling the lawn mower. Around this age we discovered he was sneaking alcohol from our liquor cabinet. Experimentation with substances continued, and by the age of 12 he was smoking marijuana. In his mid-teens he was using LSD, other hallucinogens, and amphetamines. By his late teens, he had moved on to heroin.
A Struggle to Get Sober
Aaron’s troubles went beyond substance use. When he was 14 years old I admitted him to an adolescent treatment center to undergo a mental health and chemical dependency evaluation. The psychiatrist there gave him a preliminary diagnosis of attention deficit disorder, along with oppositional defiant disorder and conduct disorder. His chemical dependency evaluation was never completed because Aaron was dismissed early after he bit an orderly who was trying to take away his cigarettes.
About a year later, I sought further evaluation from a psychiatrist who specialized in childhood behavioral disorders and addiction. He confirmed the previous mental health diagnosis and also diagnosed Aaron with substance abuse.
Aaron was soon skipping school and staying away from home. As he delved deeper into a world of drugs, it became necessary for him to deal drugs to support himself and his habit. By the time he died, he had made many attempts at recovery ranging from traditional 12-step programs to those that followed a health realization model, which focuses on “innate health” and the role of mind, thought, and consciousness in creating a person’s experience of life (Sedgeman JA, Med Sci Monit 2005;11(12):HY42–52). Many of these programs involved the use of methadone to prevent opioid withdrawal and cravings, with the ongoing use of this medication following initial stabilization.
Aaron’s last attempt at sobriety began with a rapid opioid detoxification in Chicago, a procedure that is risky, expensive, and proved to be ineffective (O’Connor PG, JAMA 2005;294(8):961–963). This was followed by hospitalization in Minneapolis to try to quell lingering withdrawal symptoms.
Ten days in the hospital did not relieve his withdrawal symptoms and the doctor’s only recourse was to put Aaron back on a small dose of methadone. At a treatment program following this hospitalization, continuing withdrawal symptoms kept him from completing the program.
Desperate, Aaron found hope in a treatment program at HealthEast Care System in St. Paul, Minnesota. [Editor’s note: Dr. David Frenz, editor-in-chief of The Carlat Addiction Treatment Report, is employed by HealthEast.] HealthEast used the blood pressure medication clonidine (Catapres) along with buprenorphine (Suboxone) to ease withdrawal symptoms. The combination proved to be helpful with Aaron’s opioid withdrawal.
One of Aaron’s treatment goals was to be free of his anti-anxiety and antidepressant medications as well as opioid agonist medications. But as his medications were reduced, Aaron became more emotionally unstable and found it increasingly difficult to remain in the inpatient program. He discharged from the program a week early with the understanding that he would participate in an outpatient program.
Aaron was released on a Tuesday and made it to the first day of his outpatient program on Wednesday. On Thursday morning I spoke to him and he said he had finished his prescriptions of clonidine and Suboxone and was not doing well. He didn’t think he would be able to make it to treatment that day. That night, he overdosed on heroin and died.
What Helped Me Cope
Within months of Aaron’s death, I began attending a grief support group for parents whose children had died. There were two positive things that I got out of this group. First, my husband, Bob, often joined me at these meetings and, here, we were able to share our grief with each other in a way that we could not always do by ourselves. Second, I developed a bond with a woman whose adult child died from complications of alcoholism. She was the only parent who really understood that addiction is a brain disease and accepted it as an illness. Although other parents attempted to be supportive, they often conveyed the feeling that addiction was a pitiful character defect that eventually caught up with Aaron.
The action that offered me the most support immediately following Aaron’s death was receiving an invitation from his attending physician to come to his office and talk. At that meeting, I expressed anger about the ways I thought HealthEast had failed Aaron.
But as I talked and he listened, it became clear that his invitation had not been extended so he could defend any issues I had with Aaron’s experience in treatment. It was extended because he genuinely cared and wanted to be a compassionate listener who grieved the loss of my son along with me.
His reaching out made me feel like Aaron wasn’t just another addict who didn’t survive. I appreciated it when he shared the positive impact that Aaron had on several other patients in the treatment program. Later, I found more support when he followed up with a letter of acknowledgement on the one-year anniversary of Aaron’s death (Bedell SE et al, N Engl J Med 2001;344(15):1162–1164).
Daily prayer and meditation were also extremely helpful. Praying for my healing as well as that of other loved ones gave me a sense of power in a completely powerless situation (Frantz TT et al, Pastoral Psychol 1996;44(3):151–163). It seemed the more I prayed and meditated, the more support I received from the least expected places.
What Hindered the Healing Process
Many of those around me did not provide the kind of support I needed and this had a negative effect on my healing process. The lack of understanding from the other parents in my grief group, while not malicious, was painful.
I was troubled when friends and family would not talk about Aaron—not just his death, but also his life. I believe this was caused by the same stigma that surrounded his life as an addict. I finally asked a friend just to say his name, “Aaron,” every time she saw me. It was comforting to hear someone else speak his name.
How Providers Can Help Families Heal
Healthcare providers can help grieving loved ones (Prigerson HG & Jacobs SC, JAMA 2001;286(11):1369–1376). I encourage those who care for a client who dies from addiction to offer their support to survivors soon after their loved one’s death.
Set up a time to meet personally and listen compassionately. Share openly what their loss meant to you. Include any personal, positive anecdotes about the client, which assures survivors that you saw them as a person, not just another client under your care. Honor the yearly anniversaries of the client’s death with a written acknowledgement to loved ones and offer them your time for another check-in.
As healthcare providers, embrace the idea that death from addiction is a different kind of grief. My experience is that death resulting from addiction holds a secondary loss—the loss of hope for your loved one’s possible recovery. Survivors may experience guilt, shame, and the resulting isolating stigma (da Silva EA et al, J Psychoactive Drugs 2007;39(3):301–306).
Providers can suggest that survivors get involved in addiction support groups such as Al-Anon family groups. Although these groups generally focus on living with someone who abuses alcohol or other drugs, members can also provide support following death due to addiction.
Finally, providers should offer specialized grief support groups not only to your clients’ loved ones but also to the wider community. You may believe that being transparent about client deaths might jeopardize your position in the community, but it does two important things. First, it provides a clear message to the community, clients, and their loved ones: addiction is a serious illness and death can and does occur if the disease is not treated with your help. Second, you will support the often-invisible survivors of clients who do not recover. This honesty and openness helps to reduce the stigma of addiction that follows clients and their loved ones in life as well as death.
Editor’s note: Gloria Englund is a recovery coach and offers grief support to others dealing with the loss of a loved one to addiction. Her website is www.recoveringu.com. She offers individual and group grief support.