“Nothing to mourn, He was just a drug addict” - stigma towards people bereaved by drug-related death

Abstract

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 drugrelated 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.

Professional helpers' experiences of assisting the bereaved after drug-related deaths: A knowledge gap

“…Particularly we will point to the association between DRD and criminality. One of the barriers to access the help system for the bereaved after a DRD that was identified in studies of the experiences of the bereaved is stigma, both self-imposed and from the professional helpers ( Dyregrov et al, 2020 ; Dyregrov & Selseng, 2021 ; Templeton et al, 2016 ; Titlestad, Mellingen, et al, 2021 ; Valentine et al, 2018 ). Self-imposed stigma is identified among the bereaved and is related to feelings of shame and guilt, particularly because drug use is a criminal activity and the drug user is often perceived to be a threat to society ( Guy & Holloway, 2007 ; Templeton et al, 2017 ).…”

“…The war on drugs by the Nixon administration in the 1970s gave a boost to the understanding of drug use as a criminal activity and has continued to have a significant effect on the treatment of drug users in the US and the attitudes towards drug users in society as a whole. Despite reforms this century that aim to reduce penalties and find alternatives to incarceration ( Corrigan et al, 2017 ), research from the US, the UK, and Norway still shows that people who use illegal drugs are stigmatised ( Dyregrov et al, 2020 ; Dyregrov & Selseng, 2021 ; Feigelman et al, 2011 ; Templeton et al, 2016 ; Titlestad, Mellingen, et al, 2021 ; Valentine et al, 2018 ).…”

Advice to policy-makers for improving services to the drug-death bereaved

“…Our participants supplied some interesting reflections on the causes of their invisibility, via a spectrum of emotions as regards the need to be understood, to be seen and respected. They also described the effects of trauma and stigma, and notions of shame and anxiety ( Curcio & Corboy, 2020 ; Dyregrov & Selseng, 2021 ). Their advice to policymakers in respect to these experiences was directed towards re-establishing dignity for drug users and the bereaved, and to develop understanding by including experience-based knowledge in service development.…”

“…The scarce research on this group supports an assumption that the grief of bereaved after DRD is disenfranchised grief, that the cause of death results in less social support and openness around the grieving process ( Doka, 2002 ; Titlestad, Mellingen, et al, 2020 ). The Norwegian Drug death related bereavement and recovery project (END) is devoted to the study of several aspects of DRD bereavement and recovery, e.g., how the DRD-bereaved experience grief and stigma and are supported by health and social care services ( Dyregrov et al, 2020 ; Dyregrov & Selseng, 2021 ; Løberg et al, 2019 ; Titlestad, Mellingen, et al, 2020 ; Titlestad, Stroebe, & Dyregrov, 2020 ). A major rationale of the project is to communicate advice to service providers and policymakers in order to reduce stigma and improve the quality of life of the bereaved.…”

Less than human: dehumanisation of people who use heroin

“…self-stigma) is associated with reduced health and social care uptake, poorer quality of care and outcomes, and reduced public support for supportive policies and services (Rivera et al , 2014; Lancaster et al , 2017; Andersen and Kessing, 2019). Negative outcomes can affect others such as family members of out-groups through processes of association (Dyregrov and Selseng, 2021), and this may also be internalised as affiliate stigma (Mak and Cheung, 2008), leading to concealment, isolation and reductions in quality of life (Marshall, 2013). Considering the large mortality and morbidity burden associated with substance use (Degenhardt et al , 2018; Lewer et al , 2019), addressing stigma is an important public health challenge (McGinty and Barry, 2020).…”