Suicide and addiction
Suicide and addiction are interlinked issues, with addiction identified as a significant contributor to suicide risk. Individuals struggling with substance use disorders (SUDs) experience higher rates of suicidal thoughts, attempts, and completions compared to the general population. The complexity of this relationship stems from overlapping risk factors such as childhood trauma, mental health disorders, and social challenges. Substance abuse impacts cognitive and emotional well-being, increasing impulsivity and aggression, making self-harm more likely, especially during crises. Alcohol and drug use can exacerbate feelings of isolation and depression, creating a vicious cycle that heightens suicide risk. Treatment approaches must recognize this interplay, advocating for holistic care that addresses both SUDs and underlying mental health issues. Effective prevention strategies include comprehensive assessment tools, increased care intensity in early treatment phases, and community-based interventions aimed at reducing access to lethal means of suicide. Understanding the multifaceted nature of this issue is crucial for improving outcomes and fostering supportive environments for affected individuals.
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Suicide and addiction
DEFINITION: Addiction is associated with suicidal behavior more frequently than mood disorders and schizophrenia. Addiction also increases social problems and mental health issues associated with suicide attempts and completed suicides. The complex relationship between addiction and suicide must be better understood to improve treatment outcomes for substance use disorders and suicide prevention programs.
Suicidality
Suicide is a serious public health problem and a leading cause of death among substance abusers and among persons who are chemically dependent. Heavy substance users are more likely than the general population to die by suicide. The risk of suicide increases as substance use progresses into abuse and addiction. Around one in five individuals who take their own life have a substantial amount of alcohol in their system at the time of their death.
Addiction is a primary contributor to suicide risk. The risk of suicide attempts is highest among people who abuse amphetamine, methamphetamine, and cocaine; however, more suicide attempts are associated with alcohol abuse because more people consume alcohol. Determining a primary substance of issue can be difficult because individuals who use substances often use multiple in combination. Individuals who use multiple substances are more likely than those who use only single substances to engage in suicidal ideation or thoughts about taking their own life.
Suicidal ideation is a predictor of suicide among individuals who abuse substances. People with substance use disorders (SUDs) who have thoughts about attempting suicide are more often depressed, take more health-related risks, and show more aggression than individuals who use substances who have not thought about suicide. Suicidal ideation often occurs during the “crash” or withdrawal, in which the pleasurable effects of a drug give way to agitation and depression, increasing the risk of suicide.
The relationship between suicide and substance abuse is complex. Suicide and substance abuse are not consequences of one single cause. They are behavioral outcomes that result from a combination of interacting stressors. The risk factors that contribute to suicide also can contribute to substance abuse.
Risk Factors
Factors associated with increased risk for suicide and addiction often overlap and include childhood abuse or trauma, sexual abuse, poor family relationships, poor communication and interpersonal conflict, family psychiatric history, unemployment and financial stress, biological correlates, impulsivity, hopelessness, previous suicide attempt, history of violence, and mental health problems including depression, bipolar disorder, and generalized anxiety disorder.
Substance abuse increases the risk of suicide by affecting cognition, mood, and impulsiveness. Substance abuse impairs judgment, increases affective instability, and reduces inhibition. This makes self-directed aggression more likely, particularly for people who have access to firearms or other means of suicide. Substance-related suicide attempts are more likely to have an impulsive component and to occur during a short-term crisis, during stress, or following a loss.
Gender also may have a part in mortality rates from suicide. Female suicide mortality rates are strongly related to alcohol consumption. The social stigma and inaccurate stereotypes attached to women with an addiction to alcohol cause guilt and shame and can serve to increase a woman’s sense of isolation and loneliness. The exacerbation of these feelings by alcohol use adds to the likelihood of suicidal ideation and suicide attempts, creating a history of suicidal behavior that, in turn, has been linked to later alcohol problems among women. Among men, serious substance abuse and addiction are correlated with higher rates of completed suicides.
The majority of persons with SUD who attempt suicide have a comorbidity, or the presence of more than one disorder that coexists with a primary disorder but may be unrelated. Depression, anxiety, attention deficit hyperactivity disorder, obsessive-compulsive disorder, bipolar disorder, or other mental health problems often coexist with a SUD. The presence of untreated mental health conditions with SUD contributes to suicidal behavior.
It is not uncommon for persons with a psychiatric illness to self-medicate with drugs or alcohol. If the person enters a treatment program or abstains from substance use, then the effects of the illness can escalate, creating stress and contributing to suicide risk. Effective prevention and treatment programs take a holistic approach, focusing on treating underlying mental health condition(s) and SUD together, especially among those who use multiple substances because they are more likely to die by suicide than other individuals with SUD.
Treatment
Treatment of addiction is an important part of a comprehensive approach to suicide prevention. Addiction counselors need to know how to screen for suicide risk and assess the risk of suicidal danger. Examples of screening and assessment tools include the Modified Mini Screen (MMS), which is used to identify anxiety, mood, and psychotic spectrum disorders, and the Addiction Severity Index (ASI), which is designed to assess seven factors contributing to substance abuse. Other helpful assessments include the Patient Health Questionnaire (PHQ) and the Columbia-Suicide Severity Rating Scale (C-SSRS). These tools help guide treatment plans and understand an individual's risk of suicide. To understand an individual's SUD and assess suicide risk, more than one assessment is sometimes necessary.
Evaluating the risk for suicide in a patient who has a substance abuse disorder is not easy. The patient may not be able to remember the details of a suicide attempt. It also may be difficult to establish that the patient intended to attempt suicide, as in the case of an overdose, which may appear to have been accidental. The difficulty in assessing and evaluating risk for suicide in addiction treatment programs and a lack of knowledge about the correlation between addiction and suicide has resulted in moving patients out of addiction treatment programs and into the mental health system. This places suicidal patients at greater risk for self-harm because the addiction, which is a primary contributor to suicide risk, is no longer being treated. To improve outcomes for persons with SUDs, suicide prevention programs should include addiction treatment programs.
Patients who are in treatment for SUDs and have attempted suicide report more psychiatric illnesses and more problematic SUDs than other patients. These patients benefit from inpatient treatment and increased intensity of care during the early phases of treatment. Motivational interviewing, which helps the patient understand the problems and consequences of substance abuse; continuing care; and psychosocial therapy, which focuses on improving communication skills and interactions a patient has with family and friends, also have contributed to improved treatment outcomes for persons with SUDs and a history of suicide attempts. Effective strategies for suicide prevention include restricting access to firearms and other means of suicide, gatekeeper training to enhance communication and intervention skills, public education campaigns, crisis hotlines, physician training, addiction treatment programs, and controlling the availability of drugs and alcohol.
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