Download the guidelines: Bereaved by substance use (PDF)

The guidelines, based on findings from a three-year Economic and Social Research Council (ESRC)-funded project, suggest that those left bereaved after a drug or alcohol related death often receive poor, unkind or stigmatising responses which can exacerbate their grief.

The study interviewed 106 bereaved adults, the largest known qualitative research sample of its kind, and held focus groups with 40 members, mainly practitioners (some also bereaved), whose work brings them into contact with this group.

While some bereaved people reported positive experiences, the study has identified much poor practice resulting from practitioners not understanding this kind of death and the issues involved.

Why such bereavements are complicated

It found that such bereavements can typically be complicated by the stress of living with the persons’ substance use prior to the death, the difficult circumstances surrounding the death and how these are sometimes reported in the press, a belief that the death was premature and could have been prevented, and feelings of guilt in not having being able to intervene.

Deaths from substance use can occur in various ways ranging from a young person who dies after experimenting with drugs to an older person who dies from liver failure after long-term alcohol use. Both the substance use and the death may be considered taboo, leaving the bereaved person feeling alienated at a difficult point in their life.

Dealing with a complex web of organisations and individuals

The researchers also highlight how bereaved people can be daunted by the myriad of different individuals and organisations they encounter after the death and propose steps for better cross-agency working. In other cases, where an individual has died in unusual circumstances, families may be offered a family liaison officer or victim support, but there is no such single point of support for people left bereaved through alcohol or drugs; something the researchers suggest could be considered.

The guidelines were developed by a working group of practitioners, including members of the police, the coroner’s court, drug and alcohol services, a paramedic, a GP, a funeral director, clergy, and a trainer / counsellor who chaired the group.

Lead researcher, Dr Christine Valentine from the Centre for Death & Society, said: “The unique combination of circumstances surrounding the death of somebody from alcohol or drug use can produce particularly severe bereavements.

“The fact that many of us feel uncomfortable or unsure about how to respond to these bereaved people, how we talk about these deaths and the limited support offered, are all symptomatic of the fact that, so far, this group, though sizeable, remains hidden and neglected by research, policy and practice.

“Our research has found that, while poor responses from services adds to their distress, a kinder and more compassionate approach can make a real difference. Our hope is that these guidelines - developed for practitioners by practitioners - will provide a much needed blueprint for how services can respond to these bereaved people.”

Key report messages

Professor Linda Bauld from the University of Stirling added: “Our findings are drawn from interviews with family members in England and Scotland but are likely to have relevance across the UK. There is much more that can be done to support bereaved family members and consider their needs rather than focus on the stigma that drug and alcohol use can carry.

“Drinking and drug use is something that cuts across all sections of society. These guidelines are relevant for a diverse range of organisations and we hope they can now be tested in practice.”

Among the report's key messages it suggests:

  • Always show kindness and compassion when interacting with a bereaved person. First impressions make a huge impression and can greatly help or hinder a person’s response to grief.
  • Think about the language you use. Avoid using labels like ‘addict’; instead talk about drug use and alcohol use. Use language that mentions the person before describing their behaviour. Avoid saying ‘I know how you feel’ and ‘You shouldn’t blame yourself’.
  • Treat every bereaved person as an individual. Do not make assumptions about the person who died and about how this kind of death may affect those left behind and how they will react.
  • Whatever your role, do what you can to protect the bereaved person’s well-being in a difficult and stressful situation. Do not be afraid of speaking to them about the death - it is often worse when it is not acknowledged. Ask the bereaved person what will help and what they want of you. Be willing to really listen.
  • Be aware of and work with other organisations dealing with this kind of death, so you can advise bereaved people about what they need to do, who they need to see next and what is going on. There may, for example, need to be a post mortem, inquest or police investigation.

The scale of the challenge

According to Alcohol Concern, alcohol-related deaths have increased by nearly 20 per cent in the past 10 years. In 2012, there were nearly 6,490 alcohol-related deaths.

The latest ONS figures highlight that 2,955 drug-related deaths were registered in 2013 for England and Wales. According to the National Records of Scotland, there were 526 drug related deaths registered in Scotland in 2013.

The authors hope their Guidelines can now be rolled out across support services.