Talking to kids about death can feel tricky and overwhelming. Talking to them about a stigmatized and confusing death, like a suicide or a drug-relate death, that can feel even trickier and even more overwhelming! With International Overdose Awareness Day coming up this week (August 31st, to be exact) we thought it might be nice to provide some tips for those of you struggling to talk to kids about a drug-related death. We have two of our fantastic social-worker-grief-friends, Sarah Montgomery and Susan Coale of the Chesapeake Life Center here to help us out:
You may remember Sarah and Susan from
their stint on Dancing With The Stars their WYG post with rockstar tips for talking with kids about suicide or when we told you about their fantastic book that helps parents, caregivers, and teachers supporting kids after a death by suicide. We couldn't be more excited to have them back.
Take it away, Sarah and Susan!
The number of overdose deaths in the US is at an all-time high. As counselors specializing in grief and traumatic death, we see first-hand how drug overdose deaths impact families and children and how loss-survivors struggle to reconcile this loss. It can be difficult to wrap our minds around the idea of explaining a drug-related death to children. Our instinct is to protect our children from heart-breaking situations, so a part of us would like to avoid having these conversations. And overdose death is sudden and complicated by nature. Similar to suicide death, we often feel that the overdose death was preventable. This can create a myriad of feelings in both adults and children including: guilt, anger, blame, worry, social isolation, and anguish about “why”.
If the person who died is a family member or friend, the child may not have been aware that she was struggling with an “addiction”. Like other brain disorders, substance use disorder is an “inside” disease and is often not talked about because of the stigma and possible judgment from others. Children often do not know that an adult has sought help or treatment for the disease, that the treatment was not helping, or that an adult had “relapsed” or begun to use the drug again. Other children may be well aware of their loved one's struggle or erratic behavior.
So how to begin? Below are guidelines we can use to address this sensitive topic:
- Take care of yourself first: The airplane analogy is an apt one — put on your own “oxygen” mask before placing one on your child. Take a couple of deep breaths and give yourself time to collect your thoughts. Think of this initial conversation as laying the groundwork, allowing the child to ask questions and exploring what the child is thinking. It is not the time to share all of the available information.
- Start the conversation: It may be uncomfortable and difficult to know where to start, but take the step. Sometimes beginning with a question is easier. For example, “What have you been thinking about Matt’s death?” invites the child to share what is going on inside. It is important that the child learns about the circumstances of the death from a caring and reliable source, not inadvertently from others.
- Name your feelings but try to keep them in check: Kids will be able to read your face—why is Mommy looking so different? Why is Grandpa shaking? When we are processing difficult news, we will experience waves of feelings; after all, we are human. Name the feeling—“I am feeling really sad right now” or “I am feeling confused and I know I am showing it.” At the same time, kids take their cues from adults, and it can be destabilizing to see a parent extremely emotional. Stay as calm as possible and take breaks when needed.
- Stick to routines: This is easier said than done, especially if it is the death of someone vital to your family’s day-to-day life. By definition a traumatic loss disrupts routine, but if you can, keep basics steady –and ask for help from friends or family if you need it.
- Talk about the person who died in a caring and respectful way: “______” (insert name here) died by an overdose, but this does not define who he or she was.” Just as a period does not define a sentence, the cause of death does not define a person. He or she is not “an overdose” but a person who died by an overdose.
- Keep it clear: Try to use language that is appropriate to your child’s age, level of understanding and previous knowledge of the situation. For example, younger children need a more concrete explanation of death and overdose: “Death means the body has stopped working” and “An overdose is when someone takes too much of a medicine or the wrong medicine and it makes their body stop working.” Offer as much clarity as possible around drugs of abuse vs. medicine that the doctor prescribes for medical needs. For example, with a prescription drug overdose, “(insert name here) used more of the medication than the doctor prescribed or was safe to use.” Or “addiction is an invisible disease that causes a person to use more (alcohol, medicine or drugs) than is safe and can end in death.” Bear in mind that there is some inherent ambiguity in the words “drug” “medicine” and even “substance.” But again, clarify that not all medicine is bad for us. Teenagers can understand more of the subtleties of language, but you must still keep it clear.
- Avoid assigning fault and blame: Underline that it is not anyone’s fault that this person died—and that the death is certainly not the child’s fault. In the course of normal development, children experience “magical thinking” which sometimes leads them to see a death as their fault. Listen for this when your child speaks. And refrain from blaming anyone for the death—even if you are angry and feel that a friend, doctor or someone else was part of the problem. This is not the time to share this.
- Guide children in learning to share appropriately: Children may need assistance in sharing with others what has happened or, in “clinical language”, creating their “own narrative.” Let them know that sharing does not mean telling everything—it is not a lie to keep some areas private. They may need guidance in answering questions from peers or community. For example, in response to the question, “How did your aunt die?” some children may want to say, “It is private” while others may want to use language such as, “She died from taking too many drugs” or “She died from an accidental overdose” or “She had an inside illness.”
- Remember, it is not a “one-and-done” when talking about traumatic loss: Let children know that they can ask questions and that you may not have all the answers, but that any questions are OK to ask. Most children process a little nugget at a time and will need to ask and re-ask questions. Take the time to gently correct inaccurate information.
- Model self-care: “When I am sad and upset, I like to exercise and talk with friends … what helps you?” Encourage kids to draw, talk, dance—anything to move their feelings from entirely internal to external. Teach them that asking for help is a sign of strength. For example, when a child is in a challenging sports tournament, music competition, or advanced Greek exam, she needs some extra guidance or coaching, right? Well, let them know that asking for assistance in any difficult time is healthy and strong.
Be sure to remind the child that if they themselves ever struggle with their feelings, there is always help available. You might help them to identify the people around them who are available to lend a listening ear during difficult times. It is also helpful to work with them to discover what safe activities bring them a sense of comfort and control when they are distressed, such as drawing pictures of their feelings, petting their cat, or sleeping with a beloved stuffed animal.
Substance abuse and overdose loss are complicated topics and difficult even for sensitive and attuned parents. Please reach out to a mental health provider if you need additional support or if you have on-going concerns. Remember, it is a sign of health to ask for guidance in times of need.
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