Families Bereaved by Drug and Alcohol Deaths: Scale, Stigma and Support

Deaths linked to drugs and alcohol leave very large numbers of people bereaved. In the United States, about one adult in three has known someone who died of an overdose^[1]. The research that follows these families, mostly from the US, Norway and the UK, finds heavier grief, raised health risks and stigma, and support that reaches only some of the people who need it.

A death linked to drugs or alcohol often comes after years of worry about the person who died. It can be followed by a police investigation, an inquest or another official inquiry into the death. Then come conversations in which the cause of death draws judgement. Parents, partners, brothers and sisters, children and friends can find that the people around them are unsure what to say, or say the wrong thing. This study brings together the best published evidence, from any country, on how many people this affects, what happens to their health, how services respond, and what support reaches them.

Millions of deaths a year, and many more people bereaved by each one

The World Health Organization estimates that, in 2019, 2.6 million deaths worldwide were attributable to alcohol, 4.7% of all deaths, and 0.6 million to psychoactive drug use. Of these, 2 million of the alcohol-attributable deaths and 0.4 million of the drug-attributable deaths were among men, and the highest proportion of alcohol-attributable deaths (13%) was among people aged 20 to 39^[4]. These are modelled estimates, not counts, and they include deaths in which alcohol or drugs were one contributing cause among others.

National death records give a closer view, though each country defines and counts these deaths differently, so the figures below cannot be compared directly with one another.

Two things stand out. First, these deaths fall mostly on men and on people in mid-life: in Scotland, 63% of drug misuse deaths in 2024 were of people aged 35 to 54, and men were more than twice as likely as women to die this way^[8]. In the UK, the alcohol-specific death rate for men remained around double that for women^[9]. Those left bereaved are therefore often the parents, partners, brothers and sisters, and children of people in the middle of their lives. Second, the narrow official measures undercount. The UK’s alcohol-specific measure, for instance, “does not include all deaths that can be attributed to alcohol”^[9].

Very few countries count the bereaved directly. The best estimates come from the United States. In a nationally representative survey of 2,479 adults in March and April 2023, 32.0% reported knowing someone who had died of an overdose. That loss was more common in lower-income households (39.9% among those earning under $30,000, against 26.0% among those earning $100,000 or more)^[1]. A separate modelling study, combining national survey data with death records, estimated that 321,566 children were bereaved of a parent by overdose between 2011 and 2021. The rate rose from 27.0 to 63.1 per 100,000 children over the decade, and was highest among children of American Indian and Alaska Native parents^[2]. Children bereaved this way are covered in more depth in our study of children bereaved by drug and alcohol deaths.

Grief after these deaths is often heavier, and health risks are measurable

Grief is a normal response to a death, not a disorder. A minority of bereaved people go on to develop a diagnosable condition, such as prolonged grief disorder, post-traumatic stress disorder or depression, and the evidence suggests that minority is larger after a drug-related death. In a US study, 115 adults bereaved by overdose were compared with adults bereaved by a sudden natural death. After taking account of a number of other factors, the overdose-bereaved were “approximately three times” more likely to meet the symptom severity threshold for prolonged grief disorder, post-traumatic stress disorder and major depression. Differences in anxiety and suicide risk were not statistically significant once those factors were accounted for^[3]. The sample was recruited, not drawn at random, so it shows how much higher the risk may be, not how common these conditions are among everyone bereaved this way.

The strongest evidence on mortality comes from Norway, where researchers followed the whole population’s registers from 1986 to 2015. Parents whose child died a drug-related death had higher mortality than both parents who had not been bereaved and parents whose child died of other causes. Their risk of dying from natural causes was generally raised throughout the follow-up. Their risk of dying from external causes, which include accidents and suicide, was highest in the first two years after the death. Compared with non-bereaved parents, the hazard ratio was 4.82 for mothers and 2.50 for fathers. It stayed raised, though significantly lower, from two to ten years afterwards^[10]. Register studies adjust for some differences between families but cannot rule out all of them, and they show an association, not that the death alone caused the later deaths. The finding points to the first two years as a time when support for parents can matter most, and suicide is preventable: people who are struggling can and do find help. More on this is in our studies of parents whose child has died and of adults bereaved by suicide.

Substance use often runs through families, and grief can meet it there. In a US survey of 158 people who were grieving an opioid overdose death, supporting someone actively using opioids, or both, the death of a child by opioid overdose was associated with higher odds of increased substance use in the year that followed (odds ratio 4.10)^[11]. This was a cross-sectional survey of a recruited sample, relying on people’s own recall, so it cannot establish cause. It does suggest that bereavement support and drug and alcohol services need to be able to reach the same families, and that some bereaved people are also using substances themselves.

Stigma follows families from the inquiry into everyday life

One of the largest qualitative studies comes from the UK. Between 2012 and 2015, a University of Bath-led team interviewed 106 adults in England and Scotland who had been bereaved by a drug- or alcohol-related death, and held focus groups with 40 practitioners^[12][13][14]. It is one of the few studies we found that includes people bereaved by alcohol, which has been researched far less than drug deaths. The project found that bereaved people were often “poorly served and insensitively treated” by services^[14]. The practitioners’ analysis described those bereaved as “a poorly understood, neglected and stigmatised group of service users”. Having to “navigate unfamiliar, fragmented, and time-consuming procedures”, including police and coroner’s investigations, added to their distress^[13].

The same research found that stigma was not inevitable. In the authors’ words, “stigma can be mitigated by small acts of kindness from those encountered after the death”. They also found that “cold professionalism” was experienced as “as disturbing as explicit disgust”^[12]. How a police officer, coroner’s officer or doctor speaks to a family is part of the support they receive.

Quantitative studies in the US add to this picture. A study comparing 115 adults bereaved by overdose with 185 bereaved by suicide found no significant difference in overall levels of stigma, guilt and shame between the two groups. Among those bereaved by overdose, stigma, guilt and shame were associated with how often the person who died had used drugs, the severity of drug use in the family, and conflict between the bereaved person and the person who died^[15]. A related analysis, of 115 adults bereaved by drug deaths, 185 by suicide and 103 by sudden natural deaths, found that more of the overdose-bereaved had anticipated the death, while the suicide-bereaved were more often shocked by it^[16]. Grief that begins long before a death, and grief that others are reluctant to acknowledge, both fit what researchers call disenfranchised grief: grief that is not openly recognised or supported.

In Norway, most wanted professional help and about half received it

Few studies have measured whether support reaches people bereaved by drug-related deaths. One comes from Norway, where 255 family members and close friends bereaved by a drug-related death took part in a survey in 2018. Most reported needing professional help after the death, whatever their relationship to the person who died. About half received it, and nearly half of those were satisfied with it. Few of those with children in the family said the children had received help, and less than one-third were satisfied with the help the children did receive. The authors concluded that younger people and children “need particular recognition” and that “a family perspective from services is essential”^[17]. This was a convenience sample, not a random one.

Brothers and sisters are a group that support often misses. A Norwegian interview study of ten bereaved siblings examined why informal support from friends and wider family so often did not work for them^[18]. A 2025 systematic review of 13 articles on siblings bereaved by a substance-related death found that siblings “experienced being abandoned”, that the attitudes of others shaped their grief, and that “support and assistance resources targeted at siblings are lacking”^[19]. See also our study of sibling bereavement.

Some services are beginning to fill the gap where families first meet the system. New York City’s Office of Chief Medical Examiner has developed a family support programme specifically for people bereaved by drug poisoning^[20], and a randomised trial of peer grief support for people bereaved by overdose is under way in the US^[21]. No published trial yet shows which forms of support work best for this group.

What the evidence asks of us

The figures point to a large, mostly unseen group of bereaved people, at raised risk, who often meet judgement where they need help. The evidence suggests several things for services, funders and policymakers:

• Count the bereaved, not only the deaths. We found no estimates outside the United States of how many people drug and alcohol deaths leave bereaved. Without that, services cannot be planned to scale.
• Offer support early, and reach out. The Norwegian register evidence shows parents’ risk is highest in the first two years^[10], and most bereaved people in the Norwegian survey wanted professional help that only about half received^[17]. Contact at the point of death, such as through a medical examiner or coroner’s service, is one route being tried^[20].
• Train the people families meet first. Police, coroners’ officers, health staff and investigators shape whether families feel stigmatised. The UK research found that small kindnesses made a difference and cold professionalism did harm^[12], and its team produced practice guidelines for services, launched in 2015^[14].
• Think family, including children and siblings. Children and siblings are often left out^[17][19].
• Join up bereavement and drug and alcohol services, since some bereaved people are also using substances^[11].
• Fund research on alcohol deaths and on what works. Families bereaved by alcohol are barely studied, and trials of support are only now beginning^[21].

Language: this piece uses plain words such as “died” rather than euphemisms, because they are clearer. Where it discusses suicide, it follows the Samaritans’ media guidelines.

Why we're publishing this

People bereaved by a drug- or alcohol-related death are numerous, yet they are rarely counted and often judged. The organisations that support them have long made the case that this grief deserves the same recognition and help as any other. The published evidence supports that case. We have gathered it in one place so that those organisations, and the services and policymakers they work with, can cite it.

How to read this data

The death figures are official statistics from national agencies (the US National Center for Health Statistics, the Public Health Agency of Canada, National Records of Scotland and the UK Office for National Statistics) and Australia’s national drug-death monitoring, based on Australian Bureau of Statistics data. Each country defines drug and alcohol deaths differently, so the figures are not directly comparable, and recent years are often provisional. The WHO figures are modelled estimates of deaths attributable to alcohol and drugs, not counts. The US estimates of bereaved adults and children are also modelled, from surveys combined with death records. The Norwegian mortality study uses whole-population registers, the strongest design here, but it shows associations and cannot rule out every difference between families. The mental health, stigma and support studies use recruited or convenience samples of a few hundred people, mostly in the US and Norway. They show patterns and comparisons, not how common these experiences are among everyone bereaved this way. Most research concerns drug deaths; families bereaved by alcohol are rarely studied on their own. We found no comparable evidence from low- and middle-income countries.

Use this data

Free to cite with attribution to Understanding Bereavement. Charities, schools, services and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This study summarises published research about groups of people for general information. It is not medical advice or bereavement support, and it cannot describe or predict anything about an individual person or family. If you are worried about someone or about yourself, please speak to a GP or another qualified professional.

Sources

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