Substance Abuse and Suicide

The consistent use of alcohol and drugs can create a variety of problems. From low quality of life to legal issues to overdose, there are many life-changing consequences that someone with a substance abuse issue may encounter. Another significant risk involved with substance abuse, often overlooked by loved ones and even treatment centers, is suicide, or the deliberate ending of one’s own life.

As one of the top leading causes of death in the United States, particularly among young people, suicide can be considered one of the country’s most significant health epidemics. It is the 10th leading cause of death among all age groups in the United States and is the second leading cause of death among people aged 10-34. In 2016, almost 45,000 Americans died of suicide, with approximately one suicide every 12 minutes, and 1.3 million American adults attempted suicide 1.

Those with alcohol dependence are ten times more likely than the general population to commit suicide, and those who use drugs are 14 times more likely to do so. Additionally, 22% of suicidal deaths involved alcohol intoxication, 20% involved opiates, 10.2% involved marijuana, 4.6% involved cocaine, and 3.4% involved amphetamines 2.

According to multiple studies, over 50% of suicides are associated with dependence on drugs and alcohol, and at least 25% of people with alcohol or drug addiction commit suicide. Additionally, more than 70% of adolescent suicides are associated with drug and alcohol use and dependence 3.

The Connection Between Substance Abuse and Suicide

It is essential to understand the connection between suicide, depression, and substance abuse. Although not all individuals who experience depression have thoughts of suicide, depression is the leading cause of suicide. In 2014, about 60% of people who committed suicide suffered from a mood disorder, including major depression, bipolar disorder, and dysthymia. Many young people who commit suicide are both depressed and suffer from a substance abuse disorder 4.

A 2018 survey revealed that substance abuse was more common for adolescents and adults who suffered from mental health issues than those who did not 5. Many people who experience mood disorders will seek out drugs and alcohol to self medicate and alleviate negative feelings. Heavy use of drugs and alcohol has the potential to turn into a substance use disorder, which may increase the severity of a depressive episode, thus increasing the likelihood of suicide 6.

It is also important to understand that depression symptoms may appear during early recovery from drugs and alcohol and can interfere with someone’s recovery process. If the individual is not properly treated for depression, they may experience suicidal thoughts and may even attempt suicide. It is crucial for someone with substance abuse issues and depressive tendencies to find a treatment option that will focus on both issues 7.

Brain Chemistry

Substances of abuse can cause alterations in brain chemistry. Substance abuse alters the brain’s pleasure and reward system, causing the brain to prioritize substances over other activities that would typically create feelings of joy. The brain chemistry alterations explain why people with substance use disorders often stop engaging in activities they once enjoyed 8.

Substances also alter brain chemistry by manipulating the neurotransmitters responsible for mood and judgment, causing feelings of apathy or low motivation and creating issues with interpersonal relationships. In this case, there is a general feeling of hopelessness, which can ultimately lead to suicide if not properly treated 3.

The poor judgment caused by brain chemistry changes can cause someone with a substance use disorder to commit suicide out of impulse, rather than with a plan. People with substance use disorders and suicidal ideations have an elevated risk of impulsively attempting suicide, which is important to note, as one of the critical indicators in predicting suicide is whether or not someone has a plan 9.

Genetics

Genetics also has a role in the connection between substance abuse and suicide, as the two may have a common genetic cause. Genetic factors cause some people to have a higher likelihood of developing substance abuse disorders than others. Additionally, a family history of addiction or alcoholism creates a higher probability of developing similar issues 10.

Similarly, suicidal thoughts, attempts, and completion can result, in part, from a family history of suicide. Genetics can also play a role in developing depressive disorders and impulsive behaviors, which can ultimately result in suicide attempts, as depression is one of the leading causes of suicide 10.

Common Risk Factors for Substance Abuse and Suicide

Risk Factors for Substance Abuse

Various risk factors may aid in the development of a substance use disorder or addiction in someone who uses substances.

Common risk factors for substance abuse include health factors, environmental factors, and historical factors:

Mental Health: 11

  • Depression
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Post-traumatic stress disorder (PTSD)
  • Anxiety disorders
  • Aggressive behavior

Environmental:

  • Access to drugs 12
  • Peer pressure 13
  • Prolonged stress 13
  • Lack of adult supervision 12
  • Financial distress 12

Historical: 11

  • Early use
  • Family history of addiction
  • Childhood abuse or trauma

Risk Factors for Suicide

As with substance abuse, several risk factors may cause someone to experience suicidal thoughts and attempt or commit suicide. Risk factors for suicide also include health factors, environmental factors, and historical factors.

Mental Health: 15

  • Depression
  • Bipolar disorder
  • Schizophrenia
  • Aggressive behavior
  • Anxiety disorders
  • Substance abuse

Environmental: 15

  • Access to lethal means (i.e. firearms or drugs)
  • Prolonged stress
  • Harassment or bullying
  • Relationship issues or divorce
  • Rejection
  • Financial distress
  • Exposure to suicide

Historical: 15

  • Previous suicide attempts
  • Family history of suicide
  • Childhood abuse or trauma

As with substance abuse, no single risk factor can determine whether someone will develop suicidal ideations. It is essential to understand that exposure to these risk factors does not guarantee that someone will develop thoughts of suicide or attempt suicide.

In most cases, stress does not lead to suicide. However, if extreme distress does lead to thoughts of suicide, the verbal expression of these thoughts is not a cry for help and should be taken seriously 16.

Most Common Shared Risk Factors

Substance abuse and suicide share many common risk factors. Again, it is crucial to recognize that no one risk factor is the sole cause of suicide or substance abuse. A combination of multiple risk factors can determine whether someone might develop a substance use disorder or thoughts of suicide.

Mental Health:

  • Depression
  • Anxiety disorders
  • Aggressive behavior

Environmental:

  • Access (i.e. drugs for substance abuse, lethal means for suicide)
  • Prolonged stress
  • Financial distress
  • Exposure (i.e. peer drug use for substance abuse, exposure to suicide for suicide)

Historical: 15

  • Previous use (substance abuse) or attempts (suicide)
  • Family history of substance abuse or suicide
  • Childhood abuse or trauma

Exposure to multiple risk factors, including depression and substance abuse, does not determine with certainty that someone will consider suicide. However, if someone does express thoughts of suicide, they are always to be taken seriously.

If someone has attempted suicide in the past, they are at very high risk for doing so again when triggered. While a previous suicide attempt does not guarantee someone will attempt suicide in the future, it is vital to treat the individual and ensure their safety.

Warning Signs

While discussing suicidal thoughts is an obvious warning sign of potential suicide, it is not the only one. There are many warning signs to look out for when determining if someone is contemplating suicide. Warning signs include things someone might talk about, behavioral changes, or changes in their mood.

Someone may be at risk for suicide if they talk about 15
  • Killing themselves
  • Feelings of hopelessness
  • Their life having no meaning
  • Being a burden
  • Feeling trapped
  • Extreme pain
Someone may be at risk for suicide if they display the following behavioral changes 15:
  • Increased use of drugs and alcohol
  • Searching online for ways to commit suicide
  • Ending engagement in activities they once enjoyed
  • Isolation from friends and family
  • Sleeping more or less than normal
  • Visiting or calling people to say goodbye to them
  • Giving away possessions that are important to them
  • Unusually aggressive
  • Abnormal fatigue
Someone may be at risk for suicide if they display one or more of the following moods 15:
  • Depression
  • Anxiety
  • Loss of interest
  • Irritability
  • Shame and guilt
  • Anger and agitation
  • Relief or sudden improvement

If someone is displaying these warning signs, it is essential to take them seriously, even if they are not verbally expressing thoughts of suicide. A stressful event may trigger the individual and create a situation in which suicide can occur.

Prevention and Recovery

Even if someone is experiencing a substance use disorder and thoughts of suicide, the result of suicide is not inevitable. Family and friends of someone with suicidal thoughts and substance abuse issues should begin an open, honest, and non-judgmental conversation with them 17, 18.

Evidence shows that talking about suicide, providing necessary support, and reducing access to self-harm, including weapons and dangerous chemicals and substances, are a few actions that may help save a loved one’s life. Above all, contacting a mental health professional is the best way to get help for a loved one struggling with a substance use disorder and thoughts of suicide 17.

Treating withdrawal symptoms, staying in treatment, and preventing relapse is the best way for someone to recover from a substance use disorder. The reduction of withdrawal symptoms, such as restlessness, insomnia, depression, and anxiety, can make it easier to resist using harmful drugs. Treatment centers often provide medications and applications that may help the brain adapt to the absence of drugs, and counseling and other psychotherapies can help reduce the risk of relapse 19.

Suicide prevention hotlines are available all over the United States within every community. Additionally, many therapists have emergency phone numbers to be contacted in a crisis. Short-term solutions, such as having an open and non-judgmental conversation and creating a safe environment by removing any weapons and drugs, can be implemented until there is access to addiction treatment and long-term mental health counseling.

Treatment

Simultaneous treatment for both substance abuse disorders and depression can be useful, as abstinence from drugs and alcohol can decrease depression symptoms after treatment. If an individual maintains a long period of abstinence and continues to experience symptoms of depression and thoughts of suicide, it is important to treat the depression and suicidal ideation.

Many treatment centers focus on substance abuse disorders in addition to mental health issues. These treatment centers provide therapies conducted by mental health professionals that aid in recovery from drugs and alcohol while also treating depression and thoughts of suicide. Continued aftercare is another important tool that can reduce the chances of relapse and help someone to maintain healthy thoughts.

Video: "The relationship between drug abuse and suicide"

Listen to Lisa Klein and Carol Graham from a Brookings Institution event discuss the relationship between drug abuse and suicide.

“I would much rather die than go into rehab again,” says as Klein recalls what a drug rehabilitation clinician had told her.

“It’s a story of ‘you’ll do anything to relieve the pain’,” says Graham.

References & Resources

  1. Centers for Disease Control and Prevention. (2018). Preventing Suicide. Retrieved August 31, 2020, from https://www.cdc.gov/violenceprevention/pdf/suicide-factsheet.pdf
  2. Wilcox, H. C., Conner, K. R., & Caine, E. D. (2004, December 7). Association of alcohol and drug use disorders and completed suicide: An empirical review of cohort studies. Retrieved August 31, 2020, from https://pubmed.ncbi.nlm.nih.gov/15555812/
  3. Miller, N. S., Mahler, J. C., & Gold, M. S. (1991). Suicide risk associated with drug and alcohol dependence. Journal of addictive diseases, 10(3), 49–61.
    https://doi.org/10.1300/J069v10n03_06
  4. Digital Communications Division. (2014, September 16). Does depression increase the risk for suicide? Retrieved August 31, 2020, from https://www.hhs.gov/answers/mental-health-and-substance-abuse/does-depression-increase-risk-of-suicide/index.html
  5. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health
    indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (HHS Publication
    No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality,
    Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
  6. NIDA. 2020, July 13. Addiction and Health. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/addiction-health on 2020, August 31
  7. Center for Substance Abuse Treatment. Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery.
    Treatment Improvement
    Protocol (TIP) Series, No. 48. HHS Publication No.
    (SMA) 13-4353. Rockville, MD: Substance Abuse and
    Mental Health Services Administration, 2008.
  8. NIDA. 2020, July 10. Drugs and the Brain. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain on 2020, August 31
  9. Center for Substance Abuse Treatment. Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2009. (Treatment Improvement Protocol (TIP) Series, No. 50.) Part 1, Chapter 1, Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment: Information You Need To Know. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64025/
  10. Wilcox H. C. (2004). Epidemiological evidence on the link between drug use and suicidal behaviors among adolescents. The Canadian child and adolescent psychiatry review = La revue canadienne de psychiatrie de l’enfant et de l’adolescent, 13(2), 27–30.
  11. Mayo Clinic. (2017, October 26). Drug addiction (substance use disorder). Retrieved August 31, 2020, from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
  12. NIDA. 2020, May 25. What are risk factors and protective factors?. Retrieved from https://www.drugabuse.gov/publications/preventing-drug-use-among-children-adolescents/chapter-1-risk-factors-protective-factors/what-are-risk-factors on 2020, August 31
  13. MNT Editorial Team. (2018, October 26). Addiction: Risk factors for addictive disorders (T. J. Legg Ph.D., CRNP, Ed.). Retrieved August 31, 2020, from https://www.medicalnewstoday.com/articles/323467
  14. NIDA. 2020, July 13. Drug Misuse and Addiction. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction on 2020, August 31
  15. American Foundation for Suicide Prevention. (2020, January 24). Risk factors and warning signs. Retrieved August 31, 2020, from https://afsp.org/risk-factors-and-warning-signs
  16. National Institute of Mental Health. (2019, July). Suicide Prevention. Retrieved August 31, 2020, from https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml
  17. The National Suicide Prevention Lifeline. (n.d.). We Can All Prevent Suicide. Retrieved August 31, 2020, from https://suicidepreventionlifeline.org/how-we-can-all-prevent-suicide/
  18. Mayo Clinic. (2017, October 26). Drug addiction (substance use disorder). Retrieved August 31, 2020, from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
  19. NIDA. 2020, July 10. Treatment and Recovery. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery on 2020, August 31