About this blog
Grief after a substance-related loss can be complicated, messy, and deeply personal. In this blog, I reflect on losing my cousin, Thomas, to an overdose and my grandfather, Tom, after his long-term struggle with alcohol. I explore the complicated grief that can come with substance use, including love, anger, guilt, relief, unanswered questions, and the experience of grieving someone while they are still alive. I also reflect on what these experiences have taught me through my work with individuals and families affected by substance use. Most importantly, I share why remembering the whole person, not just their substance use or the way they died, is such an important part of grief. I also discuss some of the somatic tools that have helped me move through grief and reconnect with myself when emotions feel overwhelming.
For this newsletter blog, I wanted to focus on something that is both deeply personal to me and incredibly relevant to the work that I do: substance use, loss, and grief. This is not an easy topic for me to write about because I have personally experienced the loss of people I love through substance use. I lost my cousin, Thomas, through an overdose involving medication and alcohol, and I also lost my grandfather, Tom, whose long-term struggle with alcohol ultimately contributed to his death. Even writing that brings tears to my eyes. More recently, I was invited to attend a substance use and loss event, and that event became one of the main reasons I wanted to write about this topic. It was a beautiful and emotional event where people were able to come together, remember the people they had lost, and grieve in a space where the complicated nature of substance use loss was understood. Being there gave me an opportunity to grieve the loss of both my cousin and my grandfather in a way that I think I had needed for a long time.
A deeply personal topic
When I found out that Thomas had died, I was at a friend’s house. I received a call early in the morning telling me that my cousin had overdosed on medication while drinking alcohol. He was alone in what was supposed to be a safe house, a place that was supposed to help keep him safe, but unfortunately, things happened that night and we ultimately lost him. There is something particularly difficult about knowing someone was in a place that was supposed to be safe and still didn’t make it home. Thomas and I were close. He wasn’t my cousin by blood, but honestly, that distinction never really mattered to me. Our families had known each other for years. My dad had known his dad since my dad was eighteen, and because of that, we grew up together. We went on vacations together, spent time together, and shared so many experiences that he was family in every sense that mattered.
Thomas and I were both kind of weird outcasts in our own ways, and I think that was part of why we connected. We had similar music tastes, and he introduced me to Eminem. He was part of a heavy metal and screamo band and had guitars everywhere. He had really great taste in music and was always introducing me to something new. He was also the kind of person who would give me advice that essentially came down to, “Forget the haters,” and he would somehow find a song to go along with that message. I remember him headbanging in the car, and sometimes I can still picture him stimming around the house. There are little phrases and mannerisms that I still associate with him, including the phrase “I concur.” Those small things become so meaningful after someone dies because you don’t just grieve the major moments. You grieve the weird little things, the inside jokes, the songs, the phrases, the way someone moved, and the things you never realized you would miss until they were suddenly gone.
I knew Thomas struggled, but I didn’t know the extent of what he was struggling with. I never knew that he was dealing with drugs or alcohol to the extent that he was. Looking back now, there are things about Thomas that I understand differently. He had behaviors that, had he been evaluated, may have resulted in an autism diagnosis. He had intense physical stims. He would skip incredibly high in the air, flick his wrists, and move in ways that were very much his own. He also loved working with and supporting individuals with intellectual and developmental disabilities, and that was an area where he seemed to feel comfortable. It was a population he connected with, and I think it gave him a sense of belonging. He was definitely high functioning in the way I understood him at the time, but I sometimes wonder what it would have been like if he had been diagnosed and had a better understanding of why he experienced the world the way he did. I wonder if not having that understanding contributed to some of the feelings he may have had about being alien, foreign, or like he didn’t belong. I don’t know the extent of what Thomas went through internally, and I never will. I don’t know everything he was feeling, thinking, or experiencing. I can only look back on what I knew and wonder about the things I didn’t.
Ultimately, I think Thomas struggled with belonging. I think he struggled with feeling like he fit somewhere and with understanding where he belonged in the world. That is something I think about a lot when I think about his death. I wish I knew more. I wish I had understood more. I wish there had been more opportunities for him to understand himself and for the people around him to understand him. But grief leaves us with a lot of unanswered questions, and unfortunately, there are some questions that will never have answers.
Grieving in the Body: Somatic Tools
One thing I have learned through my own grief is that grief isn’t only something I experience emotionally. I also feel it physically. There have been moments when I have noticed tightness in my chest, heaviness in my body, tears that seem to come out of nowhere, or a sense that I need to move, breathe, or simply pause. Somatic tools have helped me create space for those feelings instead of trying to push them away. Sometimes that has looked like taking slow, intentional breaths and focusing on the feeling of my feet on the ground. Other times, it has meant going for a walk, stretching, shaking out tension, putting a hand over my heart, or simply noticing what I am feeling in my body without judging it. Grounding through my senses has also helped, paying attention to what I can see, hear, feel, and physically experience in the moment.
These practices don’t make the grief disappear, and they aren’t meant to. For me, they create a way to stay present with the grief without becoming completely overwhelmed by it. They remind me that I don’t have to fix the feeling or make it go away. Sometimes I just need to allow myself to feel it and give my body permission to move through it. I have found that giving myself that space has been an important part of processing grief rather than feeling like I need to immediately move past it.
How these losses shaped me and informed my social work practice
My grandfather, Tom, is another loss that shaped the way I understand substance use and grief. His story was different from Thomas’s, but it was still connected to substance use and mental health. My grandfather struggled with his mental health throughout much of his life. My parents have shared that he experienced depression for a significant portion of his life, and while I didn’t get to spend as much time with him as I would have liked, I still have some fond memories of him. Ultimately, his relationship with alcohol became increasingly destructive, and he essentially drank himself to death. In some ways, the grief surrounding my grandfather felt different because his family knew that his health was declining and that his drinking was taking a serious toll. It became less about wondering if something would happen and more about knowing that something probably would happen eventually. There was a sense of waiting for the inevitable, and that is its own form of grief. Sometimes you begin grieving someone before they are actually gone. You grieve the person they used to be, the relationship you wish you could have had, and the possibility that maybe someday things would change. Then, when they die, you are grieving all of those things at the same time.
This is something I think about frequently in the work that I do because I see families experiencing this kind of grief while their loved one is still alive. I see families who are begging their loved ones to change. I see families watching someone use substances over and over again, experiencing overdose after overdose, and desperately trying to figure out what they can do to keep that person alive. Families may pursue treatment, hospitalization, higher levels of care, holds, medications, boundaries, and countless other interventions because they are terrified that the next time their loved one uses will be the time they don’t come home. There is so much love behind those actions, but there is also so much fear, exhaustion, anger, helplessness, and grief.
One of the most difficult things about substance use disorders is that wanting someone to change does not necessarily mean that person is ready or able to change. Families can love someone more than anything in the world and still be unable to make them stop using. Professionals can provide treatment, resources, education, safety planning, and support, but ultimately, there are limits to what we can control. This is one of the hardest realities for families to accept because when someone you love is actively using, it can feel like there has to be something more you can do. There has to be another program, another facility, another intervention, another hold, or another conversation that will finally make things different. Sometimes those things help, but sometimes they don’t.
I have seen this complexity firsthand in my work. For confidentiality, I won’t share identifying details, but there is a client who has struggled significantly with fentanyl use. His family has repeatedly tried to pursue higher levels of intervention in an effort to keep him safe and away from substances. There have been situations where those interventions have provided structure and safety, but there have also been repeated relapses. Every time he returns to using, it seems to become more dangerous. Eventually, we have to step back and ask ourselves a difficult question: Is what we are doing actually helping this person?
That question is incredibly complicated because from the family’s perspective, they are trying to keep their loved one alive. They may feel that if we aren’t pursuing every possible intervention, then we aren’t doing enough. From the client’s perspective, however, those same interventions may feel restrictive, unwanted, or ineffective. As professionals, we can find ourselves caught in the middle of those two perspectives. We want the person to survive. We want the family to feel supported. We want to reduce harm. We want recovery to be possible. But we also have to recognize that we cannot force someone into wanting recovery. There are limits to what treatment facilities can do, there are limits to what families can do, and there are limits to what professionals can do. That doesn’t mean we stop caring. It means we have to be honest about what is and isn’t within our control.
I think one of the biggest things I have learned through my own experiences and through the work I do is that grief related to substance use is rarely simple. There can be love and anger at the same time. There can be sadness and relief. There can be guilt, resentment, confusion, and unanswered questions. There can be moments where you desperately wish you could go back and change something, and there can also be moments where you are simply exhausted from watching someone you love to hurt themselves. Families can experience what is sometimes described as ambiguous loss, where you are grieving someone who is still physically present, but whose substance use has changed the person, the relationship, or the life you once knew. Then, if that person dies, the grief can become even more complicated because you aren’t only grieving the death. You are grieving everything that happened before it, the relationship you had, the relationship you wanted, the recovery you hoped would happen, the conversations you never got to have, and the future you thought might still be possible.
People are more than their substance use
I also think it is important to remember that people are more than their substance use. I don’t want Thomas or my grandfather to become stories that are defined only by how they died. Thomas was funny, weird, creative, and passionate. He loved music, played guitar, worked with people he cared about, and had mannerisms that made him uniquely himself. He was my cousin and someone I loved. My grandfather was also more than his alcohol use. He was a person who struggled with his mental health, carried out his own experiences, and had a life that existed long before alcohol became such a significant part of it. Substance use can become such a dominant part of the story after someone dies that we forget there was an entire person underneath it. I don’t want to do that.
The event I attended recently reminded me of why these conversations matter. Families need spaces where they can talk about their losses without judgment. People need to be able to say, “I loved them, but I was also angry with them.” They need to be able to say, “I tried everything I could.” They need to be able to say, “I’m relieved they aren’t suffering anymore, and I feel guilty for feeling relieved.” They need to be able to say, “I miss them.” They should be able to grieve without feeling like they have to explain or defend the circumstances surrounding someone’s death.
Substance use does not make someone less worthy of being mourned. An overdose does not erase someone’s life. An alcohol-related death does not erase someone’s humanity. A family does not stop loving someone simply because that person struggled with substances. Sometimes the hardest part of this work is accepting that we cannot save everyone. We can provide resources. We can create safe environments. We can offer treatment. We can educate. We can practice harm reduction. We can support families. We can continue showing up. But ultimately, recovery is something a person has to participate in, and that reality can be devastating for families who would do absolutely anything to save their loved one. It can also be devastating for the professionals who care about them.
When I think about Thomas now, I don’t want my first thought to be his overdose. I want to remember him headbanging in the car. I want to remember his music, his guitars, his weirdness, his stimming, his sense of humor, and his “I concur.” I want to remember my grandfather beyond alcohol, too. I want to remember the person and not just the way the person died.
Remember the whole person
I think that is one of the most important things we can do when someone dies from substance use: remember the whole person. Remember who they were before their addiction became the thing everyone noticed. Remember who they loved, what made them laugh, what they were passionate about, what made them uniquely themselves, and the moments that had nothing to do with substance use at all. Substance use may have been part of their story, but it was never the entirety of it.
Grief is complicated. Substance use is complicated. Recovery is complicated. Loss is complicated. There isn’t always a clean ending or an easy answer. Sometimes all we can do is continue showing up, continue caring, continue learning, and continue making space for people to grieve. Sometimes remembering someone exactly as they were, their flaws, their struggles, their weirdness, their humor, their love, and everything in between, is one of the most meaningful ways we can keep them with us. Thomas and my grandfather were more than the ways they died. They were people who mattered, people who were loved, and people whose lives continue to impact the people they left behind.