Addiction leads people down different paths that include all kinds of pitfalls, risks, and consequences along the way. But one that is rarely thought of or talked about is suicide. Suicide is the intentional taking of one’s life. The longer people abuse addictive substances, the more they are at risk for engaging in actions that could end their lives.
According to a January 2018 fact sheet published by the World Health Organization (WHO), nearly 800,000 people around the world die of suicide annually. In the United States, suicide, a preventable cause of death, is the 10th-leading cause of death. WHO recognizes suicide as a public health priority and says raising community awareness and breaking down taboos is key for countries to make suicide prevention effective.
People who die by suicide are affected by various factors that lead to such a final decision. Suicidal behavior is complex and the reasons for it are not always clear. Risk factors that affect a person who is suicidal include a person’s age, gender, ethnicity, and others. Other risk factors include:
- Suicidal thoughts
- Previous suicide attempt(s)
- Family history of mental disorder/addiction
- Family history of suicide
- Family violence (ie. physical or sexual abuse)
- Firearms being present in the home
- Exposure to other people’s suicidal behavior
- Drug and alcohol abuse
While there is not one cause of someone deciding to take their own life, research suggests that addiction and suicide are linked and that the ties between the two grow stronger the longer drugs and alcohol are abused.
Past research seems to suggest that people with a substance use disorder are more likely to die by suicide than the general population, according to a Psychology Today article on the subject. It also notes that in addition to substance abuse increases the likelihood that one will die from suicide, substance abuse is also used as a means to do it. “Roughly 1 in 3 people who die from suicide are under the influence of drugs, typically opiates such as oxycodone or heroin, or alcohol. Poisoning is the third-leading method used in suicide deaths, and drugs make up 75 percent of suicide deaths due to poisoning,” the article says.
How Substance Abuse, Suicide are Linked
There are several ways substance abuse and suicide are connected. At first glance, one may not understand the direct link between the two. But consider why addiction care and health care professionals believe them to be connected.
- People under the influence of drugs and alcohol do not think clearly. Impaired memory and judgment are often problems that accompany chronic abuse, so people lose their inhibitions and take risks that are out of the ordinary for them. If they have been having suicidal ideations (the idea that death is the final solution for problems) or thinking about suicide, then they may feel emboldened to go through with their plan because of a loss of inhibition.
- Many people who abuse drugs, alcohol, and other addictive substances do so because they have a mental health disorder and are trying to relieve symptoms of that disorder. This condition is also known as co-occurring disorders, comorbidity, or dual diagnosis.
It means that in addition to a substance use disorder, they may have anxiety, depression, Post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, or other mood or mental disorders.
Dual diagnosis can be either the reason people abuse addictive substances or come to abuse them after developing a mental health disorder. It is not always clear which one comes first, especially if they happen at the same time or one right after the other. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), it should not be assumed that one disorder is not the cause of the other, even if one of the illnesses occurs first. It is common for substance users to self-medicate to manage the effects they experience as a result of their mental health disorder. However, the longer they do, the worse their symptoms and situation become.
Suicide risks increase when people have co-occurring disorders. Of all of the mental health disorders that exist, the American Association of Suicidology reports that depression is the most prevalent one that people have. This means suicide, addiction, and depression are intertwined to form a never-ending maze for people who can’t find their way out. People who have alcohol or drug dependence in addition to being depressed are at greater risk for suicide.
As explained by the National Institute of Mental Health, depression is a real illness that interferes with one’s daily life and normal functioning. The person with depression is affected as well as the person’s loved ones. It affects people in different ways, and if you or someone you know has depression, you are not alone. Depression is treatable. Many people do not just “snap out” of depression. They require treatment to improve.
Depression often follows life’s uncertainties and hardships such as:
- Job loss
- Long-term unemployment
- Financial problems
- Chronic pain
- Chronic illness
- Living in an abusive relationship
- Breakup of a relationship (divorce, separation)
- Long-term isolation or loneliness
- Death of a spouse, parent, child, friend or loved one
- Fear about future happenings
People who are depressed commonly show signs of:
- Being persistently sad, anxious, numb/empty
- Extreme hopelessness, pessimistic
- Loss of interest in activities
- Decreased energy, fatigue/feeling slowed down
- Difficulty concentrating, remembering, or making decisions
- Heightened anxiety and/or panic attacks
- Appetite, weight changes
- Insomnia or other sleep disturbances
- Worthlessness or low self-esteem
- Irritability, restlessness, and agitation
They also may think about death or suicide, talk about suicide, or have a prior history of suicide attempts. Many people who live with depression and chronic pain are more likely to turn to drugs and/or alcohol to manage their symptoms. Alcohol use, as well as opiate use, has been linked to high suicide risk. Research indicates that 90 percent of people who die from suicide were battling depression, substance abuse, or both before taking their last breath.
Alcohol Abuse and Suicide
Alcohol use disorder, also known as alcoholism, can increase someone’s depressive state or cause them to become depressed as they use. This connection keeps people trapped and they are advised to seek professional help to get them out of this abusive pattern.
The dangers of alcohol are shielded by its acceptance by society and widespread availability.
However, one stark reminder of just how dangerous alcohol can be is how many people die from it. The U.S. Centers for Disease Control and Prevention report that about 88,000 people died from excessive alcohol use between 2006-2010.
Too much alcohol use is harmful. Excessive alcohol consumption includes binge drinking, heavy drinking, and drinking done by pregnant women and people under age 21.
Over time, the mind and body are adversely affected by health problems and injuries that are intentional and unintentional.
The disease of alcoholism can and often does play a role in suicides. Heavy alcohol use alters brain chemistry, causing disturbances in moods, behavior, and sleep patterns, and these changes create an environment in which suicide becomes a possibility.
Alcohol dependence and suicide are related because of:
- Increases impulsivity while decreasing inhibition
- Increases a negative self-image/lowers self-esteem
- Deepens depression and widens social isolation
The U.S. Department of Health and Human Services (HHS) highlights national surveys that help us better understand the relationship between alcohol and other drug use and suicidal behavior.
HHS writes on its site: “In a large study following adults who drink alcohol, suicide ideation was reported among persons with depression. In another survey, persons who reported that they had made a suicide attempt during their lifetime were more likely to have had a depressive disorder, and many also had an alcohol and/or substance abuse disorder. In a study of all non-traffic injury deaths associated with alcohol intoxication, over 20 percent were suicides.”
Other Abused Drugs and Suicide
Past research has asserted that some people who use and abuse particular types of substances may be more likely to exhibit suicidal behaviors. People who use opiates, cocaine, and sedatives may have a higher risk of suicide than people who use other drugs.
Opiate Use And Suicide
The National Institute on Drug Abuse reports that people who use opiate drugs outside of a doctor’s prescription are more likely to consider suicide than those who use the medications properly or not at all. The severity of use can be a determining factor of suicidal thoughts.
In the 2009 National Survey on Drug Use and Health, 37,933 respondents were asked if they thought about suicide or had attempted suicide in the past year. The results of a study of their responses found that the” risk for suicidal ideation was greater in those who no longer used prescription opioids, in persistent users, and among nonmedical users who had a prescription opioid disorder compared with users without the disorder.” Researchers also wrote, “The results suggest a need to continue monitoring for suicide risk even among those who have stopped using prescription opioids.”
Stimulant Use And Suicide
The use of stimulant drugs can also increase suicide risks for people who use them. A 2014 study by researchers at the University of Montreal concluded that the use of stimulants such as cocaine and amphetamine is linked with a nearly two-fold of the likelihood of suicidal behavior among people who inject the drugs.
A news release about the study’s findings says, “At the beginning of the study, nearly six percent of participants had indeed reported a suicide attempt in the previous six months, a dramatically higher rate than the general population. During follow-up, 143 participants experienced at least one episode of attempted suicide. The researchers found that chronic and occasional use of stimulant drugs such as cocaine and amphetamines was associated with nearly two-fold greater odds of reporting an attempt than the use of other drugs to report a suicide attempt.”
The news release goes on to say that the researchers did not observe the same positive association with other substances, including opiates. Researchers said the differences maybe because there are neurobiological, behavioral, and social differences between people who use stimulants and people who use opiates. They also note that drug treatment programs are often structured around opiates or alcohol and that cocaine addiction treatments are “virtually non-existent.”
Benzodiazepine Addiction And Suicide
Benzodiazepines (benzos for short), the class of drugs commonly prescribed to treat anxiety and insomnia, may also affect suicide risks, particularly during the withdrawal stage or the rebound symptoms stage. Benzodiazepines are powerful drugs that hook people who take them illegally as well as those who have legitimate prescriptions for them. According to benzos and suicide research done by Dr. Tyler J. Dodds, M.D., and published on the website of the Benzodiazepine Information Coalition, “discontinuation, reduction in dosage, or missed doses may lead to emergence or exacerbation of these same symptoms,” which are those seen during the rebound or withdrawal stage. Dodds wrote, “More research is needed to clarify the safest manner in which to taper benzodiazepines in patients at risk of suicide.”
Cannabis and Suicide
Marijuana (cannabis) is another drug that of as harmless because of its availability and acceptance. Even the legalization of it in some U.S. states has given the impression that it is not as dangerous as it can be. Heavy cannabis smoking, however, has been linked to suicidal ideation or suicidal thoughts. These thoughts can include having the idea of killing oneself cross the mind of having a well-thought-out plan.
Researchers at Louisiana State University found that people who smoke weed daily have more suicidal thoughts than people who use it less frequently. Heavy smokers were also found to experience feelings of alienation than non-heavy users. The researchers, however, were not certain if the heavy users in the study were self-medicating depression with marijuana, or if the marijuana was causing their depression.
Identifying Substance Abusers at Risk of Suicide
Just as with many things, people who think about suicide are different and therefore exhibit different warning signs. There are common signs and symptoms to look for, but there is always the possibility that some people’s warning signs may look different from what has happened or may not manifest at all. The Suicide Awareness Voice of Education shares that these are the warning signs or indicators a person may be in acute danger and may need urgent help. They are:
- Talking about wanting to die/kill oneself
- Looking for a way to kill oneself
- Talking about feeling hopeless/having no purpose
- Talking about feeling trapped/being in unbearable pain
- Talking about being a burden to others
- Increasing alcohol or drug use
- Acting anxious, agitated, or reckless
- Sleeping too little or too much
- Withdrawing or feeling isolated
- Showing rage or talking about seeking revenge
- Displaying extreme mood swings
Additional signs include:
- Crying episodes
- Increased isolation
- High-risk behavior
- Giving away belongings
- Increased impulsivity
- Inability to concentrate
- Saying final farewells to people
- Sudden change in mood that indicates happiness*
*This happens because people who take this position have made up their minds that suicide is the answer to their problems.
Suicide Prevention and Addiction Recovery
As mentioned above, suicide is a preventable death. Part of suicide prevention is identifying mental health disorders early and providing effective and comprehensive treatment for them. Without that, it will be difficult to accomplish the goal of preventing suicide among the population of dually diagnosed people or people with a substance use disorder.
If you or someone you know is suicidal, call 911 for immediate attention. Getting a screening for behavioral issues is one way to help someone who is suicidal. Such as screening can look for:
- Alcohol addiction
- Bipolar Disorder
- Eating Disorders
- General Anxiety Disorder
- Post-traumatic disorder
- And other issues
How Addiction Treatment Can Help
Addiction is said to be treatable, not curable. After one has undergone a medical detox and medical assessment, they will enter an alcohol or drug rehab treatment program that could offer a residential or outpatient setting among others.
Once in that setting, psychotherapies such as Cognitive Behavioral Therapy (CBT) can be used to help to recover substance users understand of the reasons behind their addiction. This psychotherapy aims to help people change unhealthy ways of thinking and behaving and replace them with the tools that can help them identify distorted thinking and develop specific problem-solving and coping skills so they can make better choices. It is believed therapies like this can give people in substance abuse therapy the motivation to change, manage their drug and/or alcohol cravings, and improve their mood.
CBT can help recovering users understand how drug and alcohol use are risk factors for suicide. Therapists also can help them understand thoughts, actions, or emotions that can make them feel turn to drugs or alcohol or feel suicidal. Stressors can be environmental or social and lead to anxiety or other mental health disorders.
In addition to CBT, rehab clients can enhance their treatment experience by combining CBT with other kinds of therapy, from holistic to individual, family, or group. Treatment plans are tailored to the specific needs of the person in recovery, so no two look the same. It is important to create a treatment plan that addresses the physical side of addiction as well as the mental and emotional sides of it.
A treatment plan should also be adjusted as needed during the recovery process to ensure the client is receiving the care they need. California Highlands Vistas can help you or your family member with finding the treatment plan that is right and effective for you.
Relapse and Addiction Recovery
Relapse, the return to using addictive substances after a period of not using, is often addressed in addiction recovery. Addiction recovery always includes the possibility of relapse. Because addiction is a chronic brain disease that changes the physical shape of the organ and how it functions, it is common for relapses to happen as a result of these changes.
It is part of the experience, and the best way to prepare for it is to expect it. The National Institute on Drug Abuse (NIDA) reports that relapse happens to 40 percent to 60 percent of people in recovery, which is similar to other chronic illnesses such as diabetes, high blood pressure, asthma, and others.
Relapse is not a moral failing, and NIDA advises that it be seen as a sign that substance treatment needs to be reinstated or adjusted. Another form of treatment may need to be used because it is effective.
In addition to this reality, members of the dually diagnosed population who receive treatment must also prepare for the possibility of a return to suicidal thinking after they finish treatment.
Suicide risks can return during the substance withdrawal period or when rebound symptoms occur. The early recovery period for a substance user can be rough and those first few weeks or months can feel like an eternity. There are highs and lows experienced, and the lows can perhaps make users in this situation feel hopeless.
Without addiction treatment, some people will not endure this process without wanting to go back to using drugs and/or alcohol. The use of these substances can raise suicide risks, which puts users back in the same dark place they just left.
Recovery from addiction is an ongoing, lifelong process. It is not quick or easy and it likely will be necessary to continue some form of ongoing treatment.
Since depression is the primary mental health disorder that can lead to suicide, it is perhaps important to watch for depression-related relapse triggers. If these triggers are not identified, it will be easy to fall back into the addiction cycle, which can lead to suicidal thoughts or actions.
Triggers can be anything from dealing with an illness or ending a close relationship to feeling overwhelmed or judged or criticized. Treatment can help clients recognize their own triggers, but these are just a few of many.
The more support one receives, the better the chances are that the person will avoid relapse. Joining aftercare programs is important to stay true to recovery goals post-treatment.
Find a supportive network with people who have similar goals, understand your experiences, and can help you along the way. Joining an alumni group or free programs such as SMART Recovery can keep you on track and make you feel less alone in the journey to recovery. Also, consider finding sources who have access to information about education and employment opportunities.
To avoid a relapse into depression, Health.com advises you:
- Talk to relatives or friends in your support network and tell them what’s happening.
- Alert your doctor and ask for advice and direction, regarding taking medication, going to the hospital, or seeing a therapist/crisis counselor right away.
- Get someone to stay with you until you feel better, especially if you feel suicidal.
- Take some time off from work or your personal obligations so that you can see about your health.
If you or a loved one is feeling depressed, do not isolate yourself. Staying connected to others and your environment are important in helping you avoid slipping into a worse psychological state.
Being There for Someone Who is Suicidal
If you have a loved one who is dealing with substance addiction and suicide, you may not know what to do, where to go, or how to support the person. NIMH advises that people who have loved ones with depression should help them get a diagnosis or treatment.
The institute also advises that supporters:
- Offer emotional support, understanding, patience, encouragement
- Talk to their loved one who is depressed and listen carefully
- Never dismiss feelings but point out realities and offer hope.
- Never ignore comments about suicide
- Report comments to your loved one’s therapist or doctor
- Invite your loved one out for walks, outings, and other activities
- Keep trying if they decline
- Provide assistance in getting to doctor’s’ appointments
- Remind your loved one that the depression will lift