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The Connection Between Substance Abuse & Suicide

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Although suicide is generally not caused by just one factor, suicide and substance abuse are serious problems that are often closely linked. If you or someone you know abuses substances, you probably want to know more about the connection between drug abuse and suicidal ideation, behaviors, and attempts. However, if you or your loved one is in danger, call the National Suicide Prevention Lifeline 1-800-273-8255 or 911 immediately.

Suicide is a Rising Problem

Substance abuse and mental health.Suicide rates have been increasing in almost every U.S. state. The most recent statistics from the Centers for Disease Control and Prevention (CDC) indicate that nearly 45,000 Americans age 10 or older died from suicide in 2016. As the 10th leading cause of death overall, suicide is a major public health issue.1

Suicide is usually influenced by a combination of factors, not just one. Some of the risk factors for suicide include:1

  • Relationship problems or losing/ending a relationship.
  • Drug and alcohol abuse.
  • Physical health problems.
  • Stress due to work, legal, or financial issues.

It’s not always obvious when someone is thinking of suicide, but it’s important to be aware of some of the warning signs a person might display, which can include:2

  • Exhibiting severe mood swings.
  • Sleeping too much or not enough.
  • Saying that they feel like a burden to others.
  • Talking about wanting to die or wanting to kill themselves.
  • Looking for a method to kill themselves, like buying a gun or looking online.
  • Expressing hopelessness.
  • Using increasing amounts of drugs and alcohol.
  • Behaving recklessly or acting agitated or anxious.
  • Withdrawing or socially isolating themselves.
  • Exhibiting rage or talking about wanting revenge.

If you live with someone who may be depressed or suicidal, it’s important to remove their access to materials that could cause self-harm or death, such as firearms or medication. Furthermore, if you feel depressed or suicidal, it’s important to seek immediate mental health attention in the form of counseling or rehab. Depression and suicide are very complex mental health concerns that require professional treatment.

Understanding Co-occurring Disorders

Suicide is one of the main causes of death among people suffering from substance addiction. Having a dual diagnosis or co-occurring mental health condition, such as depression, anxiety, or bipolar disorder, increases the risk of suicide even more.3

Seeking help for addiction.According to the Substance Abuse and Mental Health Services Administration (SAMHSA), about 7.9 million American adults had a co-occurring disorder in 2014. Co-occurring disorders can affect anyone, but they are especially common among people who are homeless, veterans, or in the criminal justice system.4 Compared to the general population, individuals who have an addiction are about twice as likely to have an anxiety or mood condition.5

Oftentimes, mental health disorders and substance addictions fuel each other, which can make it difficult to discern which came first and even more difficult to recover from. The reasons for common co-occurrence are unknown, but researchers hypothesize that substance abuse may induce symptoms of mental illness. On the flip side, research also suggests that mental conditions can lead to substance abuse, possibly as a form of “self-medication,” to relieve unwanted symptoms.5

This combination of factors can make addiction recovery a very challenging undertaking for someone with a co-occurring disorder, and it is one of the key reasons why a comprehensive and integrated treatment program that addresses both disorders is necessary.5

Alcohol Abuse & Increased Risks

Alcohol is one of the most commonly abused substances in the United States. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that in 2015, about15.1 million had an alcohol use disorder (alcoholism). Furthermore, around 88,000 people die due to alcohol-related causes each year.6

People who are treated for alcohol abuse or dependence are “at about 10 times greater risk for suicide.” Additionally, alcohol plays a role in around 30–40% of suicide attempts or completed suicides.3

Struggling with an addiction.

The reasons for this are complex, but one of the main issues is that one of the short-term effects of alcohol abuse is disinhibition.11 With less restraint, the individual may be more likely to attempt suicide. Alcohol can also induce depression when you stop drinking (during withdrawal).8 This depression may lead to suicidal ideation or attempts. Furthermore, during withdrawal, you may experience confusion, hallucinations, and delirium, which may make you more likely to attempt self-harm.8,10

Some people think that alcohol might help them to complete suicide without pain. With this in mind, people with an addiction to alcohol who are also suicidal may be more likely to make or complete suicide attempts. Around 22% of suicide deaths involved a blood alcohol level at or above the legal limit.11

The Impact of Drug Addiction

Some commonly abused drugs include heroin, prescription painkillers, benzodiazepines, marijuana, cocaine, MDMA (ecstasy), and methamphetamine. Chronic drug abuse can lead to persistent brain changes which are thought to play a role in the eventual development of an addiction. Over time, these neurochemical changes can make it exceedingly difficult for you to quit or control your drug use. People who are addicted to or dependent on substances may have up to a 6 times higher chance of committing suicide.12

Approximately 20% of suicide deaths involved opiates (including heroin and prescription opioids), 10.2% involved marijuana, 4.6% involved cocaine, and 3.4% involved amphetamines. In 2011, around 230,000 emergency-room visits were due to drug-related suicide attempts.11 Between 2005–2011, there was a 51% increase in emergency room visits involving drug-related suicide attempts in Americans aged 12 and older. The highest percentage of these visits involved people between the ages of 18–29 and 45–64.13

The importance of assessment.Although drug addiction can increase the risk of suicide, there are countless addicted individuals who don’t attempt or complete suicide, so the risk factors must be explored. For example, older individuals struggling with addiction have an increased risk of attempting suicide than younger people. A mood disorder, such as depression, can increase the risk of committing suicide. Addicted people who are suicidal tend to have behavioral and emotional problems, such as impulsiveness and inability to control behaviors. The specific drug being abused also matters. In addition to alcohol, heroin and sedatives are most common substances involved in suicide attempts.12

Some drugs can worsen symptoms of mental illness, and some drugs can increase the chances that you will develop the symptoms of a mental illness (including depression). For example, some research has shown that marijuana can increase the chances of schizophrenia, while amphetamines can increase the chances of psychosis.14

An additional risk includes the presence of certain withdrawal symptoms, such as depression and anxiety, that may also increase the chances of harming yourself or committing suicide. For example, sedative and benzodiazepine withdrawal can lead to increased anxiety and hallucinations, while opioid withdrawal is associated with severe depressions that can lead to suicide.14

Seeking Necessary Treatment

Detox is often the first step of recovery for people with a dual diagnosis. Detox helps you stop using the substance(s), assists you in staying comfortable and safe as you go through withdrawal, and provides support as the substance is eliminated from your body. The goal of detox is to achieve a medically stable state so that you can then enter treatment.16

Mental health and addiction.There are a number of detox settings for people who have a dual diagnosis. That being said, inpatient detox is usually the preferred setting for people who have co-occurring disorders, since in addition to generally more intensive treatment needs, suicide risk may be high. Inpatient, and particularly medical inpatient detox, can help you stay safe by offering around-the-clock care and supervision, medication and medical intervention to address potential complications, as well as access to therapy and other forms of support. Additionally, inpatient detox is a completely separate environment from the one where you were using and thus provides structure, both of which are very important to help you stay focused while you become clean and sober.16, 17

Remember that detox is not a substitute for substance abuse treatment, but rather the first step in a comprehensive rehabilitation plan. After detox, people who have a dual diagnosis need to transition to a dual diagnosis treatment center (with inpatient treatment being the preferred setting) for integrated care that will address both conditions and therefore prevent the risk of relapse.17

A dual diagnosis rehab center helps treat the addiction as well as the mental health condition. Rehabs offer different therapies and treatments to help you stay clean and sober. For example, rehabs often provide services such as individual counseling, family therapy, group therapy, 12-step groups, vocational training, health services, and more to provide you with as much support as possible as you start the path to recovery. You might participate in therapies, such as cognitive-behavioral therapy (CBT) to address unhealthy thought and behavior patterns, or motivational enhancement therapy to help you stay motivated in treatment.

You don’t have to let addiction and mental illness rule your life. Admitting the need for help and finding a dual diagnosis detox or treatment program are vital steps you can take to make a positive change and take back control of your life.

Other Available Resources

People at risk of suicide often don’t know where to seek help. You can help save someone’s life by providing information about resources and referring them to treatment.

You can contact the following resources if you need assistance or want to learn more about suicide prevention, or if you have any questions about mental health or substance abuse:

  • National Suicide Prevention Lifeline at 1-800-273-8255. Anyone who is in distress, contemplating suicide, or wants to know more about how to help someone in need can call this hotline 24/7 for free, confidential support.
  • National Alliance on Mental Illness at 1-800-950-NAMI (6264). This hotline is available Monday–Friday between 10 a.m. and 6 p.m. ET. You can get more information about mental health and mental illness from trained staff and volunteers.
  • Crisis Text Line by texting “HOME” to 741741 to text live with a trained crisis counselor.
  • SAMHSA’s National Helpline at 1-800-662-HELP (4357). The hotline for the Substance Abuse and Mental Health Administration, which is available 24/7, 365 days a year, provides information on mental health and substance abuse concerns, as well as referrals to treatment.

Even when times seem dark, suicide is never the answer. Reaching out for help is not a sign of weakness–it is a sign of strength that can help you or your loved one hold on to hope and see the light through the darkness. Caring and concerned professionals and volunteers are available across the U.S. to assist you or your loved one in recovering from mental illness and beginning the road to a happier and healthier life.

Sources

  1. Centers for Disease Control and Prevention. (2018). Suicide Rates Rising Across the U.S..
  2. National Suicide Prevention Lifeline. Warning Signs.
  3. Love, C., Davidson, L. & Valenti, M. (2014). Understanding the Connection Between Suicide and Substance Abuse: What the Research Tells Us.
  4. Substance Abuse and Mental Health Services Administration. (2016). Co-Occurring Disorders.
  5. National Institute on Drug Abuse. (2011). Comorbidity: Addiction and Other Mental Disorders.
  6. National Institute on Alcohol Abuse and Alcoholism. (2017). Alcohol Facts and Statistics.
  7. National Institute on Alcohol Abuse and Alcoholism.  Alcohol’s Effects on the Body
  8. U.S. National Library of Medicine. (2017). MedlinePlus, Alcohol Withdrawal.
  9. U.S. Department of Health and Human Services. (2008). Does Alcohol and Other Drug Abuse Increase the Risk for Suicide?
  10. Chick. J. (2015). Suicide, Self-Mutilation and Delirium Tremens. Alcohol and Alcoholism, 50(4), 377–378.
  11. Substance Abuse and Mental Health Services Administration. (2016).  In Brief: Substance Use and Suicide: A Nexus Requiring a Public Health Approach.
  12. Dragisic, T., Dickov, A., Dickov, V., & Mijatovic, V. (2015). Drug Addiction as Risk for Suicide AttemptsMateria Socio-Medica27(3), 188–191.
  13. Drug Abuse Warning Network. (2014). Emergency Department Visits for Drug-Related Suicide Attempts Have Increased.
  14. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  15. Rethink Mental Illness. (2018). Drugs, Alcohol and Mental Health.
  16. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. 1. Overview, Essential Concepts, and Definitions in Detoxification. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  17. National Alliance on Mental Illness. (2017). Dual Diagnosis.

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