substance abuse

What I Wish I Had Known Before My Brother Died

My brother Patrick died of a heroin overdose a year ago. It goes without saying that it’s been a tough year. His death caused the rawest, most piercing emotional pain that I’ve ever felt, and its effects ripple through aspects of my life on a daily basis.

Since Patrick died, I’ve read and thought a lot about grief — read pieces about how to process loss, read firsthand accounts of other people who’ve lost loved ones to addiction. I’m not sure if they’ve been helpful. Some have, I guess, but my overarching takeaway from this entire category of writing is that grief is immensely and necessarily personal. The weight of its burden can’t be shared, not in any meaningful way, and it strikes me that these “How To…” guides miss their mark simply because they arrive too late. What good is a “Learn How To Swim” pamphlet once you’ve already been thrown into the deepest end of the ocean?

Which is why the primary audience of this writing ideally isn’t those that are in my same boat today, it’s those that are where I was before my brother died. It’s for those families that know the struggle of addiction, that know the frustrating cycles of recovery and relapse, that continually hold out hope for their loved ones while knowing at some base level that death is a possibility if addiction continues to win the war. It’s what I wish I had known before my brother died.

The Recovery World Is Made Of Humans, Not Gods (Or Devils)

Patrick’s cycle of self-destruction and recovery went back 15 years, at least. The first time he attempted suicide he was entering his sophomore year of high school. The first time he was prescribed anti-depressants he hadn’t grown underarm hair. By the time he was 28, he’d been through half a dozen in-patient drug treatment programs and countless other psychiatric evaluations, each with a slightly different diagnosis and methodology.

The pattern was predictable. He’d bottom out, often after a bender, and eventually ask for help. He’d find a new program, a new therapist, a new totem to hang his faith on. Something, anything would be different this time. The new therapists would say the old therapists were wrong. They’d tweak his meds, and it would be hard. He’d get through “the tough part” of recovery and there would be hope. Then something (anything) in the plan would go wrong, and before anyone could identify exactly what it was or how to fix it, Patrick would have already pulled the ripcord and ejected from the road to recovery altogether, flushed out of the system just to start the cycle again.

It was all incredibly frustrating, for everyone, and over the years we all lost bits of faith — in doctors and their ability to draw the line between mental health affliction and addiction, in Patrick and his ability to stick to a plan, in ourselves and our own abilities to know what constituted support and what constituted enabling.

“Once you give people the benefit of the doubt, including addicts, the world becomes a much less cynical place.”

Over the years, I personally lost faith in the rehab industry itself and the institutional hubris that keeps the machine running. I became convinced that nobody knew what they were talking about, that many professional rehab facilities were corrupt, that many therapists had God complexes and weren’t to be trusted. I don’t believe we, as a society, have an answer for addiction, and to take it a step further I think we know less about mental health than many (even those in the psychiatric field) care to admit. But this isn’t about my personal feelings about recovery, and I’ll admit my biased subjectivity on the matter, having so recently lost a loved one to this disease. It’s also not about blame.

It wasn’t until Patrick’s funeral, actually, that I stopped blaming. What struck me about that day was just how loved he was. Friends, addicts, doctors, therapists, teachers — they all came out of the woodwork to share their love of P. That’s when I realized that it was no one’s fault that “recovery didn’t work.” What mattered was that these people tried. That they cared enough about Patrick to give their time and energy, both finite and precious resources when it comes to addicts, in order to help him.

We’re all flawed and we’re all human. What’s important isn’t that we have all the answers, it’s that we try to help one another as best we can as long as we’re here. Patrick tried. His therapists tried. We all tried.

Once you give people the benefit of the doubt, including addicts, the world becomes a much less cynical place.

Self-Preservation Isn’t Worth It

While the rest of the world lost Patrick a year ago, the truth is I lost him long before that. Like so many loved ones of addicts, I felt manipulated and unappreciated, so I emotionally shut myself off from Patrick after getting burned one too many times. I wish I hadn’t, because as a measure of self-preservation, it didn’t help a bit.

There wasn’t a single breaking point. In fact, our relationship probably began deteriorating when I was still in high school. It was never that we didn’t get along, really, it was more that I developed defense mechanisms over the years to keep Patrick out and to keep my emotional distance. I wrote him off, stopped trying, stopped answering texts, and kept conversation confined to sports and music. I told myself that only Patrick could help Patrick, that maybe all he needed was some tough love and to try helping himself for a change. I prepared myself for horrible news so many times that the whole topic started feeling procedural rather than emotional, like watching an in-flight safety video. I would go through the motions, but I stopped internalizing his struggles.

“If I could do it over, I would. I’d stay open and I’d try harder. Getting tricked hurts less than regret, and so much less than death.”

And none of it mattered. When the call did come, I was blindsided. I knew what happened the second my mom briefly exhaled before speaking, but that didn’t make it hurt less. From that moment on, we were all defenseless.

Which is why I’ll always regret giving up on Patrick. The last year of his life was the healthiest and happiest stretch he ever had, and for the most part I missed it. When family and friends look back at that year and share memories, I wince with a mixture of fondness, jealousy and guilt. When we did see each other, I kept my cynical distance, protected myself from getting tricked again.

If I could do it over, I would. I’d stay open and I’d try harder. Getting tricked hurts less than regret, and so much less than death.

Fuck Heroin And All Its Friends

Patrick’s cycle of self-destruction went from dangerous-but-manageable to deadly the moment he tried heroin. Heroin is different from the others, and if there can only be one takeaway to be shared from Patrick’s death, I believe it’s that.

Heroin’s a killer. It kills indiscriminately, efficiently, despicably. It snuck up on my brother and killed him in a motel with half the dosage that he was planning on taking, because he’d been clean for over a year and his body wasn’t used to it. He was still wearing his glasses. He hadn’t unpacked his tooth brush.

Heroin is an epidemic. Patrick lost close to a dozen friends to heroin in the years before his death. He knew the dangers, and he managed them 99 percent of his waking hours, but in that 1 percent of weakness heroin won, and we all lost.

“We have to end the stigma. Stop treating addicts like lepers, and start treating the addiction like we would any other epidemic.”

As dire as this all is, there are practical measures to take, and there is hope. First and most naturally, we have to attempt to keep people from trying heroin in the first place. Prescription painkillers are overprescribed by doctors and underestimated by patients. Studies suggest that 75 percent of heroin users come to the drug via prescription opioids. These drugs are normalized. You’ve probably taken them. Somebody you know has probably abused them. They are highly addictive, but rarely demonized because they’re most popular among suburban white people.

But removing access to opioid prescriptions is not a solution in itself, and in actual fact that tactic has probably increased heroin overdoses rather than curb them. With that said, a greater focus on improving the opioid prescription process is warranted as is an increased awareness of the dangers of prescription painkillers in our homes.

The second lesson is one of Patrick’s favorite causes: We have to end the stigma. Stop treating addicts like lepers, and start treating the addiction like we would any other epidemic: with compassionate pragmatism and scientific rigor. Limiting the dangers of relapsing is just as important as stopping the relapse altogether.We need to expand access to overdose antidotes like naloxone. We need to raise awareness of good samaritan laws protecting people from legal repercussions after reporting drug overdoses. We need to invest in the research and dissemination of evidence-based drug treatment programs as well as overdose vaccines. Finally, we need to treat addicts, wherever they are, with decency, and not limit our new compassionate efforts to the suburbs where this plight is relatively new.

Final Word

If I could go back to the days, weeks, months before Patrick died, the only thing I know for sure that I’d do is call him. Tell him I care. Try to make him laugh. Let him know that for all the bullshit we’ve been through, that I don’t just love him because I have to as a brother. I love him because he’s worth loving. He’s worth fighting for.

I wouldn’t do this because I think it might save him. I’d do it because, after the world takes everything else away from us, all we’re left with is our relationships, and I probably could’ve put more into this one. What I wish I had known before my brother died is how much I’d miss him.


Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.

This post is part of Common Grief, a Healthy Living editorial initiative. Grief is an inevitable part of life, but that doesn’t make navigating it any easier. While grief is universal, we all grieve differently. So we started Common Grief to help learn from each other. Let’s talk about living with loss. If you have a story you’d like to share, email us at

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