Supporting Children and Teenagers Through Loss After an Overdose

The opioid epidemic isn’t just creating new problems — according to Dan Nelson, MD, it’s “gasoline on the fire.”

Nelson, medical director of the child psychiatry unit at Cincinnati Children’s Hospital and consultant with the National Center for School Crisis and Bereavement, works with patients who have seen loved ones lose their lives to addiction.

“It's sucked up all the resources for everybody because there's just so many people struggling,” he said.

Resources for teenagers related to the opioid epidemic often focus on their direct interactions with drugs: What should teens know so they don’t experiment with opioids (PDF, 134 KB)? How many are abusing opioids and where can they get help? But this crisis also means that children and teens are experiencing the loss of people close to them — family, friends, classmates and community members who struggled with addiction.

The USC Rossier School of Education, which offers both the Master of Arts in Teaching online and the Master of Education in School Counseling online, asked experts how the opioid crisis affects adolescents who are not using drugs themselves and what educators and other adults can do to support them after they lose a loved one.

How Does the Opioid Crisis Affect Children and Teenagers?

Teen drug use is down — rates of past-year use of heroin, methamphetamine, cigarettes and synthetic marijuana are all at their lowest since the National Institute on Drug Abuse started tracking them. However, overdoses are rising across all age groups: Data from the Centers for Disease Control and Prevention show the rate of overdose deaths increased 10% from 2016 to 2017.

Which age group is overdosing at the highest rate? The CDC data pinpoints 25- to 44-year-olds as the most at-risk cohort. Adolescents don’t fall within that range, but their parents, siblings and mentors often do.

Children and teenagers experience secondary effects of the opioid epidemic as a result — death, abuse, neglect and financial strains can all wreak havoc on the lives of adolescents when those close to them misuse substances.

Drug misuse by a caregiver is a high-risk factor for a child’s immediate welfare (PDF, 4.9 MB): Approximately 17% of child fatalities occur under these circumstances, according to a 2017 report on child maltreatment by the Children’s Bureau of the U.S. Department of Health and Human Services. Parental substance misuse accounted for 36% of the children who were removed from their homes — that’s a 5% increase from the year before and a 53% increase from the previous decade, as reported by Child Trends.

And the long-term effects of a parent’s drug use, or death as a result, are potentially life-changing for youth. These can include a number of adverse childhood experiences (ACEs) — traumatic events that occur before a person turns 18 — which can be accompanied by health problems throughout life like obesity, cancer and substance use.

For example, the unexpected death of a parent is associated with higher rates of depression, even years later. Additionally, some of Nelson’s early research shows that opioid overdoses and youth suicides are clustered, resulting in growing concern about their potential link.

Providing support for children and teenagers in the wake of a loss to opioids is vital, and it may not look the same as other kinds of grief or healing. Taking action and offering resources can help mitigate immediate and long-term effects.

How Do Children and Teenagers Respond to Drug Overdose Deaths?

Jana DeCristofaro, community response program coordinator at The Dougy Center, said that children’s reactions to grief are not inherently different from adults’ reactions. The feelings have similar roots, but they manifest in different ways because of a difference in capacity to vocalize and manage those feelings.

A child’s grief can be intertwined with the process of learning that death is permanent and universal.

“For kids, oftentimes, this will be the first time they are grappling with the idea of what it means when somebody dies,” DeCristofaro said. “That, combined with their cognitive development, affects their ability to understand what death really means.”

According to a fact sheet on grief reactions over the life span from the American Counseling Association (PDF, 97 KB) and an educational web page on bereavement reactions of children from KidsHealth, some of the most common grief reactions among children and teenagers are:

Ages 2 to 5


  • Fear of separation
  • Heightened anxiety
  • Questioning the concept of death
  • Nightmares
  • Searching for the deceased
  • Regressive behaviors like thumb sucking or bedwetting

Ages 6 to 10


  • Searching for the deceased
  • Expression through play
  • Guilt or feel they are to blame
  • Physical discomfort
  • Clinginess, not wanting to leave the house
  • Inability to acknowledge what’s happened

Ages 10 to 12


  • Trying to please adults and assuage worries
  • Anxiety about the safety of others and themselves
  • Asking questions about what happened
  • Concealing emotions
  • Worry about the logistics of death and what will happen

Ages 13 to 19


  • Difficulty in school
  • Engaging in risk-taking behaviors
  • Feeling isolated from their peers
  • Asking philosophical questions about life and death
  • Identity issues
  • Hiding their feelings

Loss after an overdose can be unique in a few ways. First, it can often come after a prolonged experience of Type II trauma. According to Dr. Lenore Terr’s research on childhood trauma, single-instance and continued trauma have different effects on youth.

Type 1 trauma occurs after a single event like a car crash or severe weather event and often leaves the child with detailed memories of the episode and misperceptions about the cause.

Type 2 trauma occurs after the repetition of events such as abuse, neglect or witnessing violence, often perpetrated by a loved one or caregiver. Children respond to this ongoing distress by dissociating from traumatic memories, engaging in self-hypnosis or blocking out physical pain.

So, when children lose the person associated with that pain, the grief can be complex.

“They've lost somebody that they love, but they’ve also sometimes lost the source of stability in their life,” Nelson said. “Or, they might have lost the source of instability or the source of chaos.”

Disenfranchised grief is grief that is “insufficiently recognized by society,” according to the Institute for Research, Education and Training in Addictions. The stigma of addiction can make people place blame on the deceased and limit the compassion they extend to those left behind. For children, this can compound their own feelings of shame or anger and make them feel like they should hide their emotions.

An article published in Recovery Plus by mental health and addiction specialist Dr. Louise Stanger also explains that feelings of guilt can be stronger because the death is viewed as preventable (PDF, 424 KB), whether it was intentional or unintentional overdose. Fear of another loved one experiencing addiction and anxiety around its unpredictability combined with the stigma of addiction can make it difficult for people to fully acknowledge what’s happened.

While there are common elements, DeCristofaro said it’s important to remember each experience with bereavement is different. But children and teenagers should know that that doesn’t make their own reactions invalid.

“Anger can be part of grief. Rage can be part of grief. Guilt, relief, happiness, joy can all be part of grief,” she said. “They don't have to be afraid of their feelings or think that they're doing it wrong.”

How Can Educators and School Staff Help Children and Teens After a Loved One Dies from Overdose?

Helping youth after they lose a loved one can feel complicated, daunting and stressful. When that loss is intertwined with the trauma of addiction and the complexity of watching a caregiver or friend experience it, providing support can feel more like navigating a minefield than anything else.

DeCristofaro said that fear of saying the wrong thing shouldn’t stop you from speaking.

“We’re all coming into this situation with a desire to be helpful and compassionate. Not many of us have been taught how to respond to people in grief,” she said. “Give yourself a little bit of grace.”

Using resources from the National Center for School Crisis and Bereavement, USC Rossier School of Education assembled some considerations and strategies for educators, administrators, school staff and community members who are trying to support youth after they lose a loved one to overdose.

Communication

Administrators should alert the school community immediately and face-to-face, if possible, whether this means calling faculty into a meeting before the school day starts or addressing students at the beginning of class. Avoiding the conversation won’t help children feel like they can talk about it openly.

Share all the verifiable facts you have without compromising the safety or feelings of the family. Clearly communicating what you do and do not know prevents potentially damaging rumors from spreading.

Use direct language, even with young children. Expressions like “passed away” or “in a better place” can be more confusing than “died.”

Administrators can monitor social media in the aftermath to see if false information is being spread and to look for signs of anger and depression.


More resources:

Sensitivity

Don’t avoid the subject. Responding to death as though it’s taboo will reinforce the idea that the child should feel ashamed or embarrassed by the loss.

Show your own emotions when talking to students and community members. Children often follow the example set by the adults they trust. Expressing grief will help them see that their feelings are a natural part of the process.

Let the students set boundaries with their teachers. If they don’t want to share the details of their loss, don’t pry. Try and point them toward places they may feel more comfortable sharing, like with counselors, friends or in support groups.


More resources:

Time

Set reminders for counselors to check in. Children will carry this loss with them in one way or another for the rest of their lives. Continue providing support beyond the initial weeks and months. Simple check-ins will help build a trusting relationship that the child may need for the long term.

Anticipate triggers like anniversaries, birthdays and special moments in the child’s life where they will feel especially burdened by loss. If someone else in the community dies as a result of an overdose, think of how that could retraumatize a child who’s already experienced a similar loss.

Give students the opportunity to remember the person they’ve lost. Having a space to share memories, celebrate their life or carry something with them can teach them that this person won’t be forgotten.


More resources:

Education

Provide extra teaching support for all students immediately through tutoring, extended deadlines and office hours with teachers. Waiting until grief manifests in their schoolwork can only compound the stress of students.

Help young students understand what death means. If you are an educator, you may be the person they look to for answers. Have a conversation about how death is irreversible and natural and can be different for people.

As a teacher, explain what addiction is and how it can be prevented. Let students ask questions about substance use, what it means and why people experience addiction.


More resources:

Citation for this content: The USC Rossier MAT online program.