What to Know About Survivor’s Guilt After an Overdose

Losing a close friend or family member to addiction is traumatic, especially when the loss is unexpected. For addiction survivors, the pain is often compounded by overwhelming guilt, feelings of responsibility or even wondering why they should live while their loved one died.

Survivor’s guilt is profound and left unchecked, it can contribute to anxiety and sadness and possibly even relapse.

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What Is Survivor’s Guilt?

Essentially, survivor’s guilt is the sense of deep guilt that an individual may feel when they survive something. It’s a term that’s commonly connected with those who’ve served in the armed forces or who survive an act of terrorism, natural disaster or other trauma in which someone else died. Generally speaking, the survivor feels unworthy that they survived a trauma when another person did not.

Survivor’s guilt is complex and each person experiences it differently. For some, it’s a passing thought that is mildly disruptive for a short time, while for others, it’s disruptive and can be the beginning of self-destructive mindsets and habits.

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What are the Types of Survivor’s Guilt?

The survivor’s guilt people with addiction feel can fall into one of two categories:

• Event-based guilt: When a friend or loved one dies of an overdose, the addiction survivor may wonder why they didn’t overdose too and want to switch places with the deceased.
• Existential guilt: When an overdose death triggers this type of guilt, it can make the addiction survivor develop unhealthy views about their history with addiction. They may also feel guilty for doing well in recovery when their loved one didn’t.

Causes of Survivor’s Guilt

Not all addiction survivors experience survivor’s guilt, even if their closest friend died of an overdose. Understanding the underlying causes of this condition can make it easy to establish the likelihood of someone in recovery experiencing it and provide useful pointers on how to deal with survivor’s guilt. Some of the things that increase the chances of someone feeling survivor’s guilt include:

• Locus of control. People who believe they’re personally responsible for what happens around them may blame themselves when their friend dies of an overdose. They may constantly revisit the moments around the overdose and feel ashamed or guilty for not controlling the outcome.
• History with addiction. Someone who introduced the person who overdosed to drugs or used drugs with them may blame themselves for their death.
• Social support. People in recovery who don’t have a sponsor, family or friends they can speak to about their grief may develop internalized guilt over the overdose death.
• Poor coping mechanisms. Recovering addicts who don’t know healthy ways of dealing with intense emotions aroused by grief may feel guilt is the right way of mourning a friend who died of an overdose.

What are the Signs of Survivor’s Guilt?

Addiction survivors may experience several psychological and physical symptoms when dealing with survivor’s guilt. Because addiction and the recovery journey can be fraught with trauma, the signs of survivor’s guilt can mimic those of post-traumatic stress disorder (PTSD).

The psychological signs of survivor’s guilt may include:

• Distressing flashbacks of past drug use or the overdose event
• Feeling anxious or irritable
• Sleep disturbance, including insomnia and nightmares
• Persistent thoughts about the overdose event
• Mood swings characterized by irritability and angry outbursts
• Depression and lack of motivation
• Thoughts of self-harm or suicide

These signs of psychological distress can also give rise to physical symptoms, such as:

• Excessive sweating
• Increased heart rate and blood pressure
• Loss of appetite
• Headaches
• Nausea

Is There a Link Between Survivor’s Guilt and Addiction?

While addiction may manifest in similar ways from one person to another, the fact is that it’s a complex condition that’s affected by social, genetic, personality and environmental factors. Just as every addiction is unique, every person’s journey to recovery is also unique. One person may get professional treatment for addiction and pursue recovery and never look back, while another person’s recovery journey may be marked by relapses.

For someone who is successfully recovering from an addiction, it may be frustrating to feel in control of their own process but unable to positively influence those they love who are living with addiction. In some cases, they may feel like they didn’t earn their success or that failure is inevitable. Dealing with emotions following the death of someone who died from their addiction can be confusing, and the individual may feel that they didn’t do enough to help them or even that they should have died instead.

For addiction survivors, guilt may accompany times when:

• They have few or no relapses while others in their support group regularly experience relapses
• They become close friends with someone who is also recovering from addiction but abruptly gives up
• A loved one dies as a result of their addiction while the individual is successfully recovering from their own

Unexpectedly losing someone to addiction is devastating, and survivors of addiction can often feel intense guilt.

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Why is it Important to Deal with Survivor’s Guilt?

For those experiencing survivor’s guilt, acknowledging these feelings is important for continued recovery. Guilt is a heavy emotion to live under and almost always has emotional and physical symptoms. For example, those with unresolved guilt may feel chronically irritable or on edge, and they may experience sleeping problems, digestive issues, muscle tension, headaches and difficulty managing emotions.

Without recognizing and acknowledging guilt associated with recovering from addiction when others have relapsed or even died, the individual may be unable to process their emotions, which may impede their recovery and general health. They may subconsciously believe that their guilt is simply the price they pay for successfully overcoming addiction when others haven’t.

Accepting these feelings as natural while understanding that they aren’t helpful and don’t reflect reality is essential for a healthy mindset and continued recovery.

What are Ways to Cope with Survivor’s Guilt?

Coping with survivor’s guilt can be a years-long process that requires deliberate action and intentionally reflecting on emotions that stem from or accompany guilt.

Allow Time to Grieve

Experiencing the loss of a friend or family member is always difficult, but grief is compounded by traumatic circumstances such as a drug overdose or a drunk driving fatality. It’s important for addiction survivors to give themselves time to process what happened and to accept the feelings that accompany loss such as anger, guilt, relief, confusion and sadness.

Talk About Feelings

Humans aren’t meant to walk through life alone, and social connections are especially important after a traumatic event. It’s common to try to suppress feelings and memories of the trauma to escape uncomfortable emotions.

While this can offer temporary relief, it can have negative long-term effects on physical and emotional health and put sobriety at risk. Individuals may benefit from reaching out to close friends and family members and talking about how the trauma affected them. Even if the person may not completely understand the intricacies of survivor’s guilt, they can still provide a listening ear and encouragement. Support groups can also be a valuable forum for sharing emotions.

For those who aren’t ready to talk about their feelings, expressing emotions through art, poetry or music can also be valuable ways to process difficult memories and emotions. Even if the individual never shares these with anyone, they can be important tools in the healing process.

Reframe Emotions

While it may not be possible to completely eliminate unwanted feelings of sadness or overwhelming guilt, over time, it is helpful to reframe them. For example, instead of feeling guilt over their own success with overcoming addiction when a loved one is still wrapped up in their own addiction, the individual can try feeling compassion instead. It’s also important to recognize that feelings of relief or gratitude for one’s own survival can co-exist with grief.

Establish a Routine

Regardless of where the individual is in their recovery process, maintaining sobriety can be an all-consuming thought that’s always at the forefront of their mind or not far below the surface. This is especially true when an individual is reminded of the seriousness of addiction when a loved one relapses or loses their life to addiction.

Willpower isn’t reliable, especially during difficult times, but habits and routines are. Keeping a tight routine, including practicing self-care, showing up at work on time, attending support groups, and exploring habits can help the individual avoid relapse and continue to move forward.

Find an Avenue for Supporting Others

Supporting others in their recovery journey can be therapeutic for those experiencing survivor’s guilt after a trauma. Whether or not the guilt is rational, it can be used to help others.

How the individual carries that out may stem from what they’ve learned on their own journey. For example, they may channel their energy into educating others to help them avoid the mistakes the individual feels guilty about or raising awareness about the cause of death. Providing a listening ear, modeling sobriety and offering compassion can be healthy ways for survivors of addiction to direct their energy and emotions.

Come to Terms with Responsibility

Perhaps the hardest obstacle in survivor’s guilt treatment is for the individual to come to terms with their role in their loved one’s addiction. This is particularly true for those who initially supplied drugs or alcohol to the lost loved one, used drugs with them, or played a role in enabling their use.

Acknowledging responsibility for a role in a loved one’s addiction doesn’t mean that the individual takes all the blame. While they may have played a part in their loved one’s addiction, chances are that they also provided support for seeking sobriety. Ultimately, it was their loved one’s choices and own personal factors that led to the relapse.

Accept That There May Be No Answers

After a traumatic event, it’s normal to want to know why something happened and how it can be avoided in the future. This is especially true of addiction survivors who may feel blinded by a loved one’s relapse or loss of life. Unfortunately, sometimes there are no answers. Addiction is complex, and we may never know why some are able to overcome drinking problems or drug use while others lose their struggle.

Ultimately, it’s important to not get lost in the “whys” but instead to focus on living life to the fullest, in honor of those whose lives were lost.

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