My siblings and I didn’t grow up in your typical “nuclear family” – our family tree has a lot of branches. For the purposes of this story, what you need to know is that my dad married my stepmom when I was a teenager, blending my step-brother and step-sister, Matthew and Kristina, with my half-sister, Natasha, and myself. Matthew, who was four years younger than me, became one of my best friends. My dad and stepmom divorced when I was in my 20s and as hard it was, I’m grateful they supported our continued relationships as siblings which ultimately shaped the paths of my personal and professional life.

While I headed off to graduate school for psychology, Matthew joined the Marine Corps at 18 and became a Reconnaissance Marine. He eventually deployed to Afghanistan and we talked occasionally via satellite phones, where the drastic differences between life as a Recon Marine and a grad student weren’t lost on me. During his deployment, I know he felt a sense of purpose and brotherhood, but I also know he was exposed to a number of blasts like many who deployed to Iraq and Afghanistan. Those blasts likely caused traumatic brain injuries, although they weren’t diagnosed or treated at the time. After that deployment, a back injury prevented him from joining his team on another tour, which was incredibly painful and eventually, he separated from the military. Inspired by his journey, I started working with veterans and active duty service members and led research on the long-term physical and mental health effects of deployment injuries, as I watched my brother living with these effects.

Without his military career, Matthew felt lost. He struggled to find purpose in his education and work. He was in his early 20s, partying, starting and stopping school, and working random jobs. At first, it didn’t seem out of the realm of what other people his age were doing, but over time, it became obvious there were problems. Without a clear path and the additive, untreated effects of PTSD, a traumatic brain injury, and chronic pain, his substance use escalated. I remember when Kristina told me that he was using heroin. Maybe it was because I was his older sister or because of my job as a psychologist, but Matthew distanced himself from me at the peak of his drug use, and when we did talk, we often argued. We all came together to support him as best we could, but after years struggling, he overdosed in 2019 at 30 years old.

That call from my sister was one of the worst moments of my life. She was hysterical, but managed to get out the words, “Matthew is gone.” It felt surreal and I remember calling her back a few minutes later, thinking I must have misunderstood, but I hadn’t. I’ll always be grateful for the kindness my stepmom and Matthew’s family showed me during that time. I wasn’t technically related to them and they could’ve easily excluded me from the grieving process, but instead, welcomed me as we collectively dealt with the numbing logistics of death – cleaning out his truck, his apartment and figuring out the details for his funeral.

I struggled to show up for months after his death – as a parent, a partner, and professional. Grief felt like walking through a fog and sometimes it would overwhelm me – usually leaving me crying in random parking lots. At first it was an acute, stabbing pain and over time it’s become a dull, subdued ache, but it’s never gone away. My career was also deeply intertwined with the struggles Matthew faced. Right around the time of his death, I published a paper about the connection between chronic back pain, PTSD and substance use. It was a stark reminder that my professional qualifications and experience, couldn’t save me from the pain I was feeling.

I know this story is not unique and that’s precisely why I felt compelled to share it. My brother knew help was available and had access to free mental healthcare through the VA, but it wasn’t approachable for him. He wasn’t interested in therapy or typical substance use treatment for most of the time he was using, which is the norm – 94% of people with substance use disorders don’t receive treatment. Whether it’s due to inaccessibility, stigma, potential negative consequences or just personal preference, the majority of people struggling with mental health and substance use aren’t going to treatment.

As clinical psychologists, we talk about therapy as the gold standard. I’m not saying it isn’t, but if only a minority of people are getting it, we need to broaden our perspective. Some of the men my brother served with have started nonprofits that create community for veterans, which is a mental health driver since we know loneliness is associated with health outcomes. If we take a more holistic approach to mental health, what else could we integrate into our models that would improve people’s quality of life? Who else could support the mission of reducing human suffering? The same can be said of substance use treatment. Rather than just getting people to stop using substances, what if we focus on building social support, increasing healthy behaviors, and gaining reinforcement from other areas of life?

The other reason I felt compelled to share this all too common tale is to keep chipping away at the stigma that surrounds substance abuse. My brother died of a drug overdose and he’s so much more than that. Addiction was only part of his story. Matthew was funny, fiercely protective, super smart, and addicted to opiates. All of these things can be true at the same time. We tend to use dehumanizing language to describe people using drugs instead of acknowledging that like all humans, people with substance use problems have full personalities and deserve dignity, love, and support.

Part of being human is experiencing emotional pain. Losing my brother made me realize emotional pain isn’t something just to be tolerated, it’s what connects us to humanity. I only felt this pain because I chose to love my brother. Nothing grounds us in our humanity like fostering loving relationships, and part of that is experiencing the pain that comes with the end of those relationships.

The last message I sent Matthew said, “I love you. Let me know when you’re ready to talk.” For the countless families with similar stories, it’s important to accept that we can’t force our loved ones to get help, but we can be there when they’re ready. For those of us thinking about the treatment side, my question is, how can we make sure those families have the resources they need and want when that time comes?

Photo: Benjavisa, Getty Images