Victim Services: Coping with Traumatic Death Due to UAD

COPING WITH TRAUMATIC DEATH AS A RESULT OF UNDERAGE DRINKING

24/7 Help Line: 877-623-3435 madd.org/help

One of the teens used his father’s credit card to buy vodka at a liquor store known for selling to minors. The party was held at a trailer where eight teens and one adult decided to spend the night. Around 5:00 in the morning, a fire started. The nine woke up and tried to get out. Six of those in the trailer that night, including Alexis, died in the fire. She was my only child, and I never thought that she would die. My worst fears as a parent were pregnancy or dropping out of school, but you don’t think about these things until it happens. Now I advocate for change, to make sure this doesn’t happen to other families. One thing I want to make sure all parents know: trust your children, but always double check what they tell you, you don’t want to be left wishing you made the call. Alexis was turning 17 and a large group of friends had planned a party for her.

Tiffany’s daughter Alexis had told her that she would be at her best friend’s house that night. Tiffany didn’t know about the party until after the fire.

TABLE OF CONTENTS

The Serious Issue of Underage Drinking Tragedies��1 Providing Alcohol to Minors��2 What Makes Traumatic/ Sudden Death Different?��3 The Traumatic Nature of the Death��4 No Opportunity to Say Goodbye��5 Death of a Child��6 Physical Responses to Traumatic Grief��6 Substance Use��7 Psychological and Emotional Responses to Traumatic Grief�� 8 Isolation�� 8 Denial��9 Fear/Vulnerability��10 Anger�� 11 Guilt�� 12 Faith/Philosophy of Life��13 Complicated Grief��14 Social Changes in Response to Traumatic Grief��17 Special Dates��17 Future Losses��18 Hard Questions��19 Healing Journey��19 Coping Tips��20 Connecting With MADD��22

The Serious Issue of Underage Drinking Tragedies Kids who have their first drink before the age of 15 have a risk four times higher of developing alcoholism. Compared with non-drinking class- mates, teens who drink are more likely to die in a car crash, take their own life through suicide, die from alcohol poisoning or be injured or die from falls, drowning or burns. One in six teens binge drink, only one in 100 parents believes his or her child binge drink. Teen alcohol use kills about 4,700 people each year, more than all other drugs combined. Mothers Against Drunk Driving, MADD, is focused on preventing these tragedies, but we are also here to help support those who have lost loved one or friend due to underage drinking consequences.

Included in this resource are some suggestions to help you cope with the death of a loved one due to underage drinking. However, keep in mind that even though your situation may share similarities with someone else, every person’s grieving process is different. Providing Alcohol to Minors All states have laws that prohibit the sale to or the possession of alcohol by those under 21 (with exceptions), and almost all states have laws that prohibit the consumption of alcohol by those under 21 (with exceptions). Some minors go to a local business that may be known in their area to provide alcohol to minors, some use a fake ID to try to purchase alcohol, or some may have an adult buy the alcohol for them. Because the sale and provision of alcohol is illegal, if you know that it is happening, or has happened, and would like to report it, there is an entity you can and should report that activ- ity to. The Alcohol Tobacco Tax and Trade Bureau provides listings of the agencies that would handle these situations for each state: ttb.gov/wine/state-ABC.shtml. Unfortunately, teens sometimes get alcohol from their parents or other adults, who think that kids should be free to learn from their own mistakes. Other parents may believe that if kids learn to drink at home, they’ll be safer. Research proves them wrong. When teens feel they have their parents’ approval to drink alcohol, they tend to drink more – and more often – outside the home. What seemed harmless at first often results in tragic consequences that parents don’t anticipate.

To find out more information about your state’s specific laws regarding under- age drinking, you can do to the website for the Alcohol Policy Information System at alcoholpolicy.niaaa.nih.gov/.

What Makes Traumatic/Sudden Death Different?

It is difficult to imagine the magnitude of pain associated with the traumatic death of a loved one. When someone is killed suddenly and/or vi- olently, grief reactions of family and friends can be intense, complicated, and long lasting. If your loved one was killed as a result of an underage drinking tragedy you may feel a depth of emo- tions you would never have thought possible. At times it may feel like you have gone crazy, but as unusual as you may feel, these responses are a normal part of the grief process related to traumatic death.

The Traumatic Nature of the Death Unfortunately traumatic death involving under- age drinking can lead to many different types of trauma to the body, including alcohol poisoning, drowning, falling from a height, assault, car crashes, death by fire and many other ways. Underage drinking consequences can have many unanticipated results and loved ones may be left trying to figure out what happened and why. In the case of alcohol poisoning, because alco- hol acts as a depressant on the body’s system, the excess alcohol may cause a person to stop breathing or prevent their gag reflex from work- ing correctly. Many people do not realize that a high level of alcohol can actually cause brain damage or even death. Sometimes those around someone who is drinking excessively do not realize the person is experiencing trauma and may leave the person to “sleep it off” and not seek the medical attention needed. Depending on how your loved one died, you may worry about what actually happened to them and if they were in pain. There are many ways underage drinking can lead to someone’s death, some of those ways can be traumatic. Your loved one’s death may or may not have been violent. You may be concerned your loved one suffered extreme pain or felt alone as they died. This is a common fear for those loved ones left behind.

Our brains have a unique way of protect- ing ourselves from feeling pain. When a person’s body en- dures trauma, they may not feel pain or they may drift in an

It may be helpful to talk about your fears or anxiety surrounding your loved one’s death.

out of conscious- ness. Researchers call this response stress induced analgesia. The body releases hormones which block pain pathways to pre- vent people from feeling pain.

When a traumatic death occurs, many loved ones want to know exactly what happened, who was with their loved one or who tried to help them. Sometimes those details will emerge from others who were present at the time and other times, those details may never fully be known. It can be a difficult thing to not know the details of exactly what happened because often your mind will go to your worst fears. It may be helpful to talk about your fears or anxiety surrounding your loved one’s death. No Opportunity to Say Goodbye After a tragedy, surviving family members and friends are emotionally assaulted. There is no time to gradually prepare for the loss. You could have never prepared for the devastating blow

caused by your loved one’s traumatic death. When someone dies due to an expected death they may have the opportunity to see or talk with their loved one. Due to the unexpected nature of traumatic death, you

Even if you didn’t get to say goodbye,

your loved one knew you cared about them.

may not have had time to say goodbye, tell them you love them or to spend time with them before

their death. Even if you didn’t have the chance to say goodbye, it’s very likely that your loved one knew how much you cared about them. Death of a Child When a child is killed there may be an additional sense of wrongness associated with the death of someone young. The loss of that person may highlight all of the things that child hasn’t yet been able to experience in their life, all of the things they will be missing out on experiencing. Having a child die implies that something un- natural has happened. After the death of a child loved ones may be terrified that another family member may be killed and go to great lengths to monitor their activities to try to prevent some other tragedy from happening.

Physical Responses to Traumatic Grief

During the first six months to a year after a fatal crash, people who are grieving are vulnerable to physical illness. Physical complaints, aches, and illness are all common after a traumatic death. Your body’s immune system is working overtime,

and you may feel worn out. This is your body’s reaction to the trauma you have experienced. You may have difficulty falling or staying asleep or constantly feel tired. You may also experience changes in your appetite. You may begin to eat less or skip meals or have a constant hunger and eat more often than normal.

During grief you may be more susceptible to physical illness, reach

out to your physician.

During this early period of grief, it’s important to eat well and get plenty of rest. If the problems persist, see your primary physician to ensure you do not have a stress-related physical condition. Substance Use Some people find the pain too difficult and may turn to alcohol or drugs to ease their pain. Unfortunately, there is no easy fix to make the loss easier to bear. Both alcohol and drugs are likely to make the situation more difficult to cope with, because both may contribute to irrational thoughts and depressed moods. Depression after a traumatic death is common. You may need short-term medication prescribed by your doctor to help you cope with everyday

stressors while grieving. If so, do not consider it a weakness. You have suffered severe trauma and deserve professional help to begin feeling better physi- cally and mentally. You may only need medication prescribed for a short amount of time. Psychological and Emotional Responses to Traumatic Grief Although everyone’s grief response is different it’s important for you to take note of those grief reactions that are particularly common so that if you experience them, you will know what’s happening to you. Some common grief reactions may include: Isolation As someone who is grieving the death of a loved one who died due to an underage drinking tragedy, you may feel isolated. There may be some people around you who fail to acknowl- edge your feelings of grief. Additional pain is felt when others fail or disregard your need for support. Regardless of the circumstances, you are a bereaved loved one who deserves support and understanding. Feelings of isolation can lead to an increase in emotional pain that can be so intense that it is almost intolerable. People who have experi- enced the traumatic death of a loved one may have problems concentrating or become easily distracted. You may start an activity and forget

what you were about to do, only to begin again. Even though you feel isolated, or that you feel like iso- lating yourself from

Everyone deals with grief differently.

others, surrounding yourself with a network of supportive people can help you when you are feeling distracted or unable to concentrate on important tasks. Denial Denial can be a wonderful thing. It is the mind’s way of buffering the full impact of a trauma until it can be absorbed. Upon learning that a loved one has been killed, most people are too weak to undertake the overwhelming task of grieving. When you heard of your loved one’s death, you may have gone into shock. Regardless of the ini- tial impact, if you are like most people, you soon found yourself in a state of numbness. Looking back now, you may wonder how you remained calm. You may have completed some tasks that now seem impossible. You probably have a hard time re- membering exactly what you did during those first few days. During this time, people may have assumed that you were strong by your actions, when in reality, you were in shock and only going through the motions. Denial following a violent and unanticipated death is considered normal and functional. It allows a person to travel through grief at their own pace and serves them well until they are stronger and better able to cope. It is impossible to push through any part of the grieving process in an attempt to get over it. If you cannot think clearly or if you seem forgetful and detached, be patient with yourself. Most importantly, if you need help, it’s ok to ask for it. If you need help, it’s ok to ask for it.

Fear/Vulnerability You may feel that life is out of balance and that the world no longer makes sense. Many victims and survivors are surprised to find that they feel anxious, fearful, and powerless after the violent death of a loved one. The part of you that was previously confident and carefree has been damaged. You see the world differently and fear comes with that. We tend to believe that good things happen to good people and bad things happen to bad people. For you, this belief no longer makes sense.

You may feel that you and your remaining loved ones are more vulnerable than other people. It is important to work up the courage to go out in public, even when it frightens you. Little by little you can overcome your fears and feelings of vulnerability.

Anger Anger is a common grief reaction. You may be angry at the person/people or establishment that provided alcohol to your loved one. You may find that your anger is directed toward members of the legal system or hospital staff. Even if it doesn’t make sense, many people direct feelings of anger at a family member or friend, or even at themselves for not having prevented something they may not have been able to prevent. You may even be angry at your loved one for making the choice to drink. Many people find it beneficial to talk with some- one about feelings of anger or rage. Expressing these feelings can free the mind, enabling you to be more open and realistic in your thinking and planning for the future. Physical activity often helps. Some people write in journals or write letters to those they are angry with, often never sending those letters but using it as a form of therapy. Some cry and yell and scream. How you

express your anger is up to you. The important thing is to acknowledge it, and to not hurt your- self or anyone else in expressing it. Guilt Anger often becomes guilt. Guilt is feeling some- how responsible for what happened or thinking that you didn’t do enough in the relationship while your loved one was alive. You may say to yourself, “If only I had known,” or “If only I told them I loved them.” Guilt involves a lot of “if only” or “should haves.” You may wonder, “What else could I have done to prevent this tragedy?” You may be experienc- ing survival guilt, asking why your loved one died or why it wasn’t you instead. The torment of what protective action may have prevented it from happening may last long after the tragedy. You may think about all of the times you talked with them, or didn’t talk with them about alco- hol. You may not have had conversations about underage drinking or getting into the car with a driver who has been consuming alcohol. It’s pos- sible that you did have the conversations, but now you are plagued with guilt about how you talked about it with them and if you should have done it differently. Regrets are normal, but you cannot change the past. Some people find it helpful to write letters to their loved ones to help them say their good-

byes. As difficult as it is, it is important to look rationally at how your beliefs make you feel guilty. You may, indeed, be responsible for some component of your loved one’s

Talking with others can help you look at your guilt realistically.

death. If so, acknowledge it and see if you can find a way to forgive yourself. If you made a bad judgment, you probably made the best one you knew how to make at the time.

Seek help right away if you are thinking about hurting yourself or someone else.

Try not to exaggerate your role in your loved one’s death. In many cases, other factors played a role in your loved one’s death. Talking with others who have some understanding of your experience can help you look at your guilt realis- tically. It will be hard work for them and for you. Feeling less guilty will not take away your sad- ness or your anger, but it can help relieve some of the stress you are feeling due to that guilt. Faith/Philosophy of Life People who have not focused on God or a belief in an afterlife before may do so in the wake of trauma. Likewise, people whose faith plays a

significant part in their lives may now start to question their faith following the death of a loved one due to underage drinking. You may have been told that your loved one’s death was God’s will; you may have been told you should forgive. Working through issues of faith may take time and can be another difficult compo- nent of grief and sometimes touching base with those connected with your faith can also add to the frustration or bring strength. Because each person’s experience is so different, surround yourself with the support that you need at the portant to know, however, that more serious psychologi- cal complications can develop over time, this is called complicated grief. When normal grief reactions become more serious and start interfering with your abilities to function both physically and emotionally it may be time to seek help. time that you need it. Complicated Grief After the death of a loved one due to an unfore- seen tragedy, grief reactions such as sadness, anxiety, anger, and fear are normal. It’s im- Some of the disorders that can naturally occur after a traumatic death include clinical depres- sion, and anxiety disorders, including PTSD (Post Traumatic Stress Disorder). Clinical Depression When people are exposed to a traumatic event, they frequently suffer psychological

consequences such as depression. For a time they may disconnect from living life, avoiding daily tasks or even loved ones, however, when time moves forward and there is no progress towards healing, it may be a sign that they are experiencing clinical depression. This clinical depression is often also biologically related to chemicals that your body may be releasing and may require medication to address. Know that there is no shame in getting help prescribed by a doctor for one of the most distressing times of a person’s life. Anxiety Disorders and PTSD Additionally, some people experience recurrent and ongoing recollections of the trauma, which can lead to distress. You may experience triggers of trauma. Sounds, smells or sights that make you think of your loved one can bring on a wave of grief that washes over you. You may wake-up in the middle of the night in a panic due to a nightmare. Moments like these typically come about without warning and over time can cause you to avoid situations that you connect with the trauma. You may feel on edge,

anxious or always ready to react. Recollections can be so painful and scary that they disrupt your normal activities and relationships. Trauma victims and survivors who consistently experience all of these symptoms for at least one month or longer may be suffering from Post-Traumatic Stress Disorder (PTSD). PTSD is an anxiety disorder that is diagnosed by a mental health professional. If you believe you may be suffering from PTSD it is important to seek professional help as PTSD is treatable with a combination of therapies which may or may not include medication.

Complicated grief can develop after a traumatic death.

Getting Help for Complicated Grief Complicated grief disorders are fairly common after a traumatic death and very treatable. There are many types of effective therapies available, it’s important to seek out a professional who is experienced in the field of traumatic grief. Professional counselors can help diffuse the im- pact of traumatic grief, sometimes by providing

emotional support or other techniques as the experience is relived. Sometimes feelings and anxieties associated with traumatic death may lead to thoughts of suicide or death. If they do, it is time to ask for help immediately. Social Changes in Response to Traumatic Grief While the initial response to the death is defined by the term grief, mourning refers to the inter- nal processes associated with adapting to life without your loved one. Some have described mourning as a “misty fog on life.” You are not al- ways aware, yet you realize that life is not quite as bright as it was before. Your values may have changed, and you may be impatient with things you deem unimportant or trivial. Special Dates Anniversaries, holidays, and birthdays often trigger reminders of the death or absence of your loved one. Perhaps the most significant and most difficult anniversary is that of their

death. The annual date or even week or month may cause anticipatory anxiety and can contribute to renewed grief for victims and survivors. Special dates can be triggers that bring about painful

Special dates can be triggers that bring about painful memories or emotions.

thoughts and emotions.

The first anniversary will most likely be the most painful. Other annual celebrations, such as birth- days, Christmas, Thanksgiving, and Mother’s/

Father’s Day will continue to take place year after year. In the past these times of joy brought your family together. Now and forever they will trigger memories

of your loved one. Today these special dates will be difficult, but later will provide you with reasons to reminisce and begin new rituals. Planning ahead for holidays and birthdays not only allows you to prepare for those events, but also provides ongoing and open commu- nication between family members. Future Losses

Mourning the loss of all of the possibilities that could have been if your loved one was still alive is something that most people experience. You may miss out on the possibility of having grand- children or having your loved one with you as you experience life events. It’s common for these thoughts to hit you at different times in your life, particularly when a celebration comes around that may be as- sociated with those future losses – such as a wedding, graduation or holidays. Thinking about these losses and acknowledging them is a part of the grieving process. Your thoughts and losses are real and something that may stay with you for the rest of your life. You may want to talk with someone or journal about the things you will miss due to your loss. Having that strong support system can be crucial, someone who

acknowledges what you are going through and will be there through it with you, sometimes that person is someone else who has gone through something similar. Connecting with others who have gone through something similar may help you cope with those losses. Hard Questions One thing you may find after the death of a loved one is that hard questions will come up for you from time to time. Questions such as, “Do you have any children or grandchildren?, or, Do you have any siblings?” If you have lost a child, grandchild or a sibling, when these questions come up you may not know just how you want to answer them. Sometimes you may want to acknowledge your loss and other times you may not feel comfortable doing so. Your answer may change, and that’s ok – answer it however you want and need to at the time, say what you are most comfortable saying. Not mentioning the death of your loved one does not diminish them or their memory. Healing Journey Your life will not be the same as it was before your loved one died. Learning to manage grief requires that you recognize and acknowledge all that is involved in the grief journey. Many people describe the grief process as a roller coaster ride with ups and downs along the way. However painful and difficult, grieving is nec- essary to heal and to find new meaning in life. Coping is an attempt to adapt your new circum- stances into your existing life and you may try a variety of means to achieve this; some may work for you; others may not. Try several to see what may work. Through this grieving process you will learn to live in your new normal.

Coping Tips • Tell your story, over and over again. • Get support from a professional counselor or support group in your area. • Talk to someone who has experienced the traumatic death of a loved one. • Write about your experience in a journal. • Seek information about your loved one’s death to answer those unanswered questions. • Understand that everyone grieves differ- ently and be especially sensitive to family members who may be grieving differently than you. • Reinvest in life by reaching out to others. • Stay connected with people who are sup- portive and understanding. • Take care of yourself physically by eating well and getting plenty of sleep. If you are afraid to get better because you think you might forget your loved one, know that you will never forget. You will always cherish the memory of your loved one. In time you will

Reinvest in life by reaching out to others.

remember the happy memories more often than the painful ones that fill your mind now. Eventually, you will be able to do things you were able to do before their death, including: • Solving problems and completing tasks in your daily routine • Sleeping well and having more energy • Feeling good enough about yourself to be hopeful about the rest of your life; • Being able to enjoy the pleasurable and beautiful things in life again. It won’t happen right away and for some it may take more time than for others. In time, and with the support of others, you will be able to achieve these things. You could not prevent the tragedy in which your loved one died. You can, however, control how you choose to cope with their death, and how you choose to live the rest of your life. For some, en- during trauma ignites a spark of activity to right some of the wrongs involved in a sudden death.

Connecting With MADD For some, enduring trauma ignites a spark of activity to right some of the wrongs involved in a sudden violent death. Most victims/survivors want to prevent it for others. Thousands of men, women and teenagers have joined Mothers Against Drunk Driving after their loved ones were killed to make a difference in their communities. Some people find it helps them enormously to work to end drunk driving and victimization. It can feel as though it is the one activity that might bring something constructive out of their loss.

Call the 24-Hour Victim Help Line at 1-877-MADD-HELP (877-623-3435) to be connected to a MADD Victim Advocate who will be ready and willing to listen and help. You can also visit us online at madd.org/help . You are not alone. To talk with someone about what you are going through, to find resources, or to get involved:

24/7 Help Line: 877-623-3435

madd.org/help

MADD does not discriminate against individuals or groups, either in employment or in the delivery of services or benefits, on the basis of race, sex, color, religion, national origin, age, income, marital status, sexual orientation, medical condition, disability or veteran status. If you believe your civil rights have been violated please reach out to the U. S. Department of Justice, Office of Justice Programs, Office of Civil Rights (www.justice.gov/crt or US Department of Justice, 950 Pennsylvania Avenue, NW, Civil Rights Division, Washington, DC 20530, or phone (202) 514-4609 Telephone Device for the Deaf (TTY) (202) 514-0716).

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