< On this Page
On This Page ×

Suicide and Substance Abuse

Every year, nearly 45,000 individuals die by suicide in the United States, making it the 10th leading cause of death in America. Loved ones struggling with the aftermath of suicide often wondered if–and how–they could have prevented it. It is important to recognize that suicide is ultimately one’s decision. Loved ones are not to blame. Nonetheless, there are certain factors associated with suicide risk that, when addressed, could save a life. Among them: Substance abuse.

Every year, nearly 45,000 individuals die by suicide in the United States, making it the 10th leading cause of death in America. Loved ones struggling with the aftermath of suicide often wondered if–and how–they could have prevented it. It is important to recognize that suicide is ultimately one’s decision. Loved ones are not to blame. Nonetheless, there are certain factors associated with suicide risk that, when addressed, could save a life. Among them: Substance abuse.

The Connection Between Suicide and Addiction

Fact: People who abuse substances are more likely to commit suicide, and addicts are overrepresented among suicide victims. There are a number of theories that may explain the relationship between addiction and suicide:

  • Disorders like depression and posttraumatic stress disorder (PTSD) can be a major cause of both substance abuse and suicide.
  • Circumstances like homelessness and job loss also contribute to both substance abuse and suicide.
  • Drugs and alcohol reduce one’s awareness and inhibitions. They aren’t thinking clearly, which might just push suicidal thoughts to action.
  • Addiction can lead to social and familial separation, job loss, financial insecurity, and other consequences that, in turn, increase the likelihood of depression and suicide.
  • Addiction and depression both have major genetic components that tend to occur together.
Expert Perspectives

“The connection between substance abuse and suicide has not been sufficiently well understood,” said Richard McKeon, Ph.D., M.P.H., Public Health Adviser for Suicide Prevention at SAMHSA’s Center for Mental Health Services in a 2009 SAMHSA newsletter. “People in both the mental health and substance abuse fields have likely had experiences that would demonstrate the connection, but I think that probably few appreciate the magnitude of the relationship between substance abuse and suicide.”

Richard McKeon

In the article, McKeon referred to a SAMHSA white paper that pinpoints substance abuse as the largest suicide risk factor and the critical need for two things. Mental health professionals need to be keenly aware of substance abuse issues while treating other issues in patients, and substance abuse professionals to be aware of the acute risk of suicide in their clients. Additionally, McKeon stressed the need for a higher level of collaboration and integration between treatment professionals.

“According to the white paper, a growing body of evidence suggests that alcohol and drug abuse are second only to depression and other mood disorders when it comes to risk factors for suicide,” wrote Rebecca A. Clay in the SAMHSA article. “In one study, for example, alcohol and drug abuse disorders were associated with a six-fold increase in the risk of suicide attempts. And substance abuse and mental disorders often go hand-in-hand, the paper emphasizes… The approach should focus on prevention just as much as diagnosis and treatment.”

Rebecca A. Clay

The SAMHSA white paper also highlighted the secondary tragedy of taboo that has prevented public health in the past from drawing attention to suicide and its complexities. With that, McKeon stressed the urgent need to focus on the intertwining complexities of substance abuse and suicide.

“There’s a need for a comprehensive approach if we want to reduce suicide attempts and death by suicide,” emphasized Dr. McKeon. “It’s not sufficient to rely simply on mental health treatment, since we know that the majority of those who die by suicide have never had any mental health treatment. To reduce suicide, everyone needs to be involved.”

Dr. McKeon

Prevention Begins With Treatment

“We worry about the addicts in our lives for good reason,” writes Carolyn C. Ross M.D., M.P.H. in Suicide: One of Addiction’s Hidden Risks. “They are at high risk of death by a number of causes including disease, accident and suicide. Suicide prevention requires a multifaceted approach, but it all hinges on the person reaching out for help and effective treatment being available when they take that brave step.”

Carolyn C. Ross

While primary care physicians are in the best position to identify suicidal tendencies, they may miss important details if not trained properly regarding warning signs and prevention. They must ask the difficult questions about whether a patient has considered or attempted suicide in the past, or if they currently think about it or plan to follow through with it. Better recognition of substance abuse issues which may lead to suicide should also be an area of focus. Studies have shown that many women and older adults have seen their primary care physicians within a year of their suicides. With better training and forthright questions, perhaps more suicides may be avoided in the future.

“We know the very serious threats facing patients with addictions and mental health disorders,” continues Ross. “We also know that integrated dual diagnosis treatment for both substance abuse and co-occurring mental health disorders by a multidisciplinary team of professionals can help people recover and prevent suicide. There are a number of promising medications, and therapies such as cognitive-behavioral therapy and dialectical behavior therapy may reduce the risk of suicide attempts by as much as 50 percent.”

Carolyn C. Ross

Other Risk Factors for Suicide

In addition to substance abuse, there are other risk factors that can play into a person considering taking his or her own life. These risk factors further highlight the need for coordination between treatment providers and include the following:

  • One or more prior suicide attempts
  • Family history of mental disorder or substance abuse
  • Family history of suicide
  • Family violence
  • Physical or sexual abuse
  • Keeping firearms in the home
  • Chronic physical illness or pain
  • Incarceration
  • Exposure to suicidal behavior in others

Signs Someone You Love May Be Suicidal

While every situation and individual is unique, research has shown that there are common signs that may indicate a person is at an imminent risk of suicide. These include but are not limited to the following:

  • Increased alcohol and drug use
  • Threats or comments about killing themselves, also known as suicidal ideation, can begin with seemingly harmless thoughts like “I wish I wasn’t here” but can become more overt and dangerous
  • Aggressive behavior
  • Social withdrawal from friends, family and the community
  • Dramatic mood swings
  • Losing interest in things one used to care about
  • Talking, writing or thinking about death or suicide
  • Impulsive or reckless behavior
  • Putting their affairs in order; giving away their possessions; tying up loose ends; changing a will
  • Saying goodbye to friends and family
  • Making comments about being hopeless, helpless or worthless
  • Mood shifts from despair to calm
  • Planning, possibly by looking around to buy, steal or borrow the tools they need to commit suicide, such as a firearm or prescription medication

The American Foundation for Suicide Prevention warns loved ones and friends to be especially vigilant if there has been an attempted suicide in the past, as between 20-50% of people who complete suicide have previously tried.

How to Support A Loved One Struggling With Addiction and Suicidal Thoughts

Suicidal thinking and substance abuse both place a heavy burden on family and friends. In addition to looking for warning signs, there are recommendations for things to do and say, especially in light of imminent danger. First of all, take it as a serious emergency.

  • Listen to the person
  • Don’t argue
  • Seek immediate help from a health care professional or emergency room and accompany him or her
  • Do not leave the person alone
  • Remove any weapons, drugs, alcohol from his or her environment

It is important for those supporting loved ones with addictions and/or suicidal thoughts to remember to take care of themselves. Many drug rehab centers have special programs designed to help friends and family members cope, including individual and group therapy and referrals to area support groups.

Fast Facts: Suicide & Drug Abuse

There were 41,149 suicides in 2013 in the United States—a rate of 12.6 per 100,000 is equal to 113 suicides each day or one every 13 minutes.1

Compared to the general population, people treated for alcohol abuse or dependence are at about ten times greater risk for suicide.

Over 200,000 emergency department visits resulted from drug-related suicide attempts in 2011.

Alcohol is present in about 30 to 40 percent of suicides and suicide attempts.

Drug-related suicide attempts rose 41% between 2004 and 2011.

Roughly one in three people who die from suicide are under the influence of drugs, typically opiates such as oxycodone or heroin, or alcohol

Based on data about suicides in 16 National Violent Death Reporting System states in 2010, 33.4% of suicide decedents tested positive for alcohol, 23.8% for antidepressants, and 20.0% for opiates, including heroin and prescription painkillers.

Depression and other mood disorders are the number-one risk factor for suicide, but alcohol and drug abuse – even without depression – are a close second.

Poisoning is the third-leading method used in suicide deaths, and drugs make up 75 percent of suicide deaths due to poisoning.

Research has shown that the strongest predictor of suicide is alcoholism, not a psychiatric diagnosis.

People with substance use disorders are about six times more likely to commit suicide than the general population.

The rate of major depression is two to four times higher among addicts than the general population.

How Communities Can Help Prevent Addiction & Suicide

Twenty-seven states mandate that teachers and other educators receive professional development training in suicide prevention. All states, meanwhile, have some type of school-age drug prevention program. Several well-known organizations have put together a roadmap called the Model School District Policy on Suicide Prevention to assist schools in developing a comprehensive prevention program which is rooted in best practices. Strategies include age-appropriate curriculum integrated into K-12 health classes and focused on safe and healthy choices and coping mechanisms. Integral to this is the discussion of the harmful results of misusing drugs and alcohol.

College Students Run an Even Greater Risk of Addiction & Suicide

Suicide is the second leading cause of death among college students, according to a 2011 study from The American Association of Suicidology entitled Alcohol-Related Problems and Risk of Suicide among College Students: the Mediating Roles of Belongingness and Burdensome. Alcohol and drugs play a relevant role.

According the American Psychological Association’s (APA) article The Crisis on Campus, mental health issues on college campuses are increasing at an alarming rate. While students sought help for depression and anxiety most frequently, suicidal ideation, self injury and substance abuse were also reported in higher numbers. According to writer Arielle Eiser, “ A 2010 survey of students by the American College Health Association found that 45.6 percent of students surveyed reported feeling hopeless, and 30.7 percent reported feeling so depressed that it was difficult to function during the past 12 months.”

The Garrett Lee Smith Memorial Act which was passed by Congress in 2004 was in response to the increase in mental health and suicides in young people, including those on college campuses. APA was pivotal in the Campus Suicide Prevention Initiative which have “made a significant difference,” according to Eiser.

Despite success, growing needs have dictated continued challenges. “College counseling centers are frequently forced to devise creative ways to manage their growing caseloads,” wrote Eiser. “For example, 76.6 percent of college counseling directors reported that they had to reduce the number of visits for non-crisis patients to cope with the increasing overall number of clients.”

Q&A with Dr. Doreen Marshall, Vice President of Programs, American Foundation for Suicide Prevention

About Dr. Doreen Marshall
About Dr. Doreen Marshall

As a psychologist and Vice President of Programs for the American Foundation for Suicide Prevention, Dr. Doreen Marshall’s experience spans clinical, educational and professional settings. She has been engaged in local and national suicide prevention work for more than a decade, joining AFSP in 2014. Since then, Dr. Marshall has expanded AFSP’s menu of education programs for both clinicians and general audiences, and revamped the infrastructure to improve program delivery through a nationwide network of chapters. She is also leading a new initiative to develop programs for people who have suffered from suicidal thinking or who have survived a suicide attempt. Marshall fosters partnerships with mental health organizations and oversees the development of new programming, including clinician trainings.

As a psychologist and Vice President of Programs for the American Foundation for Suicide Prevention, Dr. Doreen Marshall’s experience spans clinical, educational and professional settings. She has been engaged in local and national suicide prevention work for more than a decade, joining AFSP in 2014. Since then, Dr. Marshall has expanded AFSP’s menu of education programs for both clinicians and general audiences, and revamped the infrastructure to improve program delivery through a nationwide network of chapters. She is also leading a new initiative to develop programs for people who have suffered from suicidal thinking or who have survived a suicide attempt. Marshall fosters partnerships with mental health organizations and oversees the development of new programming, including clinician trainings.

[...]

Prior to joining AFSP, Marshall served as Associate Dean of Counseling at Argosy University, chaired the Suicide Prevention Coalition of Georgia, and served as Associate Director of The Link Counseling Center’s suicide prevention and aftercare program in Atlanta. She was a consultant for both national and state suicide prevention and postvention initiatives, which included providing suicide prevention training for the Division of Behavioral Health and Developmental Disabilities and serving on a task force of the National Action Alliance for Suicide Prevention.

Find More
  • Prior to joining AFSP, Marshall served as Associate Dean of Counseling at Argosy University, chaired the Suicide Prevention Coalition of Georgia, and served as Associate Director of The Link Counseling Center’s suicide prevention and aftercare program in Atlanta. She was a consultant for both national and state suicide prevention and postvention initiatives, which included providing suicide prevention training for the Division of Behavioral Health and Developmental Disabilities and serving on a task force of the National Action Alliance for Suicide Prevention.

    Marshall holds a doctorate in Counseling Psychology from Georgia State University, a master’s degree in Professional Counseling, and a bachelor’s degree in Philosophy and English from The College of New Jersey.

  • Q. Can you talk about suicide and substance abuse as a result of depression, PTSD, and similar disorders? Are there common scenarios and trends you are seeing?

    We know that suicide most often occurs in individuals who are struggling with a mental health concern like depression or anxiety. For many individuals who struggle with mental health concerns, substances have been a way to cope and self-medicate their symptoms. Many substances, like alcohol, also lessen inhibition, which can make a person more likely to follow through on a plan for suicide. Alcohol, in particular, is a central nervous system depressant which tends to make people more depressed over time. So, a person who is drinking alcohol to cope with depression may find themselves more depressed over time. We should also be mindful that substance use disorders can also be prevalent in those who are suffering from chronic pain, and chronic illness/pain is another risk factor for suicide.

    Also, data from the National Violent Death Reporting System suggests that 27-30% of people who die by suicide have a blood alcohol level in the intoxicated range at the time of death and about 22% have a documented alcohol use disorder. Data suggests that roughly a third of people who die by suicide are intoxicated at the time of their death.

  • Q. Does suicide risk impact substance abuse treatment and how it is implemented? Are there special precautions that treatment professionals and centers take to prevent suicide and how do you address suicide and depression during the treatment process?

    Those with substance use disorders are at a higher risk for suicide than those without substance use disorders, particularly when there are co-occurring mental health concerns. Often, a person may have been using substances to cope with anxiety, depression, PTSD or some other mental health concern—so it is very important that treatment acknowledges the potential impact of a person no longer using those substances to cope, as well as any other mental health concerns. Substances can mask symptoms of anxiety, for example, so it is often important to assess the person’s mental health at various points in the treatment as they begin to cope without substances.

  • Q. What is your advice to family and friends who have a loved one with substance abuse issues/risk of suicide?

    My advice to family and friends who have a loved one with substance use concerns is that the person is likely using substances to cope with some distress. Their thinking/judgment about what might help them can be very impaired. It is a time when they benefit from understanding and support, and from information about how to get help. It often takes a number of attempts to address a substance use disorder before a person is ready to try to live without the substance. As much as you can, try to be supportive as they are trying to recover. They have likely tried before, and it is very possible that this has been a way of coping for them. It is also important that a person who is trying to recover from a substance like alcohol on which they are dependent, do so with medical supervision. Help them get the help they need when they are ready to seek it.

    Have an open dialogue about suicide. If you are worried about someone, ask them if they have ever had thoughts of suicide. Listen to what they say, reassure them that help is available, and then work to connect them to help. They may feel overwhelmed and not know where to start, or may believe that their situation is hopeless and that they are beyond help. Reassure them that help is available and if you are concerned that someone might take their life imminently, take them to the nearest hospital or call the National Suicide Prevention Lifeline at 1-800-273-TALK. You can also text TALK to 741741 for the Crisis Help Line.

Q. Can you talk about suicide and substance abuse as a result of depression, PTSD, and similar disorders? Are there common scenarios and trends you are seeing?

We know that suicide most often occurs in individuals who are struggling with a mental health concern like depression or anxiety. For many individuals who struggle with mental health concerns, substances have been a way to cope and self-medicate their symptoms. Many substances, like alcohol, also lessen inhibition, which can make a person more likely to follow through on a plan for suicide. Alcohol, in particular, is a central nervous system depressant which tends to make people more depressed over time. So, a person who is drinking alcohol to cope with depression may find themselves more depressed over time. We should also be mindful that substance use disorders can also be prevalent in those who are suffering from chronic pain, and chronic illness/pain is another risk factor for suicide.

Also, data from the National Violent Death Reporting System suggests that 27-30% of people who die by suicide have a blood alcohol level in the intoxicated range at the time of death and about 22% have a documented alcohol use disorder. Data suggests that roughly a third of people who die by suicide are intoxicated at the time of their death.

Q. Does suicide risk impact substance abuse treatment and how it is implemented? Are there special precautions that treatment professionals and centers take to prevent suicide and how do you address suicide and depression during the treatment process?

Those with substance use disorders are at a higher risk for suicide than those without substance use disorders, particularly when there are co-occurring mental health concerns. Often, a person may have been using substances to cope with anxiety, depression, PTSD or some other mental health concern—so it is very important that treatment acknowledges the potential impact of a person no longer using those substances to cope, as well as any other mental health concerns. Substances can mask symptoms of anxiety, for example, so it is often important to assess the person’s mental health at various points in the treatment as they begin to cope without substances.

Q. What is your advice to family and friends who have a loved one with substance abuse issues/risk of suicide?

My advice to family and friends who have a loved one with substance use concerns is that the person is likely using substances to cope with some distress. Their thinking/judgment about what might help them can be very impaired. It is a time when they benefit from understanding and support, and from information about how to get help. It often takes a number of attempts to address a substance use disorder before a person is ready to try to live without the substance. As much as you can, try to be supportive as they are trying to recover. They have likely tried before, and it is very possible that this has been a way of coping for them. It is also important that a person who is trying to recover from a substance like alcohol on which they are dependent, do so with medical supervision. Help them get the help they need when they are ready to seek it.

Have an open dialogue about suicide. If you are worried about someone, ask them if they have ever had thoughts of suicide. Listen to what they say, reassure them that help is available, and then work to connect them to help. They may feel overwhelmed and not know where to start, or may believe that their situation is hopeless and that they are beyond help. Reassure them that help is available and if you are concerned that someone might take their life imminently, take them to the nearest hospital or call the National Suicide Prevention Lifeline at 1-800-273-TALK. You can also text TALK to 741741 for the Crisis Help Line.

Important resources

Anyone who displays a suicide warning sign should be taken very seriously. In addition to local suicide prevention hotlines, the following toll-free numbers are intended to be helpful:

  • 800-SUICIDE (800-784-2433)
  • 800-273-TALK (800-273-8255)
  • Text TALK to 741-741
  • 800-799-4889 (deaf hotline)