It is well known that addiction to drugs and alcohol is associated with a number of physical and psychological problems. However, there is one major consequence of substance abuse that is often overlooked. People with addictions are at an increased risk of taking their own life. What makes this risk even more dangerous is that it may remain under the radar while the addict’s healthcare providers, family, and friends focus on recovery from addiction.
Statistics indicate that there is a poorly understood, yet undeniable, association between risk of suicidal thoughts and substance abuse. In fact, a key component of addiction treatment is giving the addict a reason to live a fulfilling life without turning to illicit substances for artificial happiness. Without treatment, severe depression in a drug abuser or alcoholic can lead to fatal and non-fatal attempts at self-harm. Read on to find out how to recognize and manage suicidal thoughts in substance abusers and how to lower the risk of suicide in an addict.
Understanding Suicide: An Untimely End
In the last decade or so, suicide and addiction have been claiming an increasing number of lives. Both lead to an untimely end to a promising life. Poverty, poor health, and social isolation are well-known reasons for someone to take their own life. In addition, addiction is a leading cause of suicidal thoughts and attempts. The statistics are sobering. Worldwide, about 800,000 people kill themselves each year. This means one person takes their own life every 40 seconds. In the United States, close to 45,000 people willfully ended their life in 2016. Keeping in mind the stigma associated with suicide, it is possible these figures are an underestimation. What causes a person to end their life? And what is the reason for this ominous increase in self-harming behavior?
Experts cannot agree on what is driving an increase in suicide rates. Some people believe the economic downturn of 2008 had an effect similar to the Great Depression of the 1930s. Others point out that the rates were increasing even prior to 2007 and the real reason is increasing social isolation and failing marriages. Whatever the reason, according to the World Health Organization, globally, suicide rates have increased by 60 percent since World War II. In 2010, suicides claimed more lives than war, murder, and natural disasters put together. It is estimated that for every person that kills themselves, at least 20 more make an unsuccessful attempt at ending their life. Add to these grim statistics a burgeoning alcohol and drug abuse crisis in America (there were 33,000 opioid overdoses reported in 2015 alone), and the link between these two types of self-harm cannot be ignored.
Many creatures in the natural world exhibit self-sacrifice. Parents of nearly every species go to great lengths to protect and feed their young ones. Yet, all these sacrifices can be traced to a survival of the species and evolutionary traits. Human beings are the only creatures that can suffer from a hopelessness so deep that death seems like the only relief from the anguish. Humans are also the only species that falls prey to chemical dependency and a downward spiral that ends in death.
A few theories have been put forward to explain what causes a person to willfully end their life.
Causes for Suicide
|Mental Health Disorders||Depression, Bipolar, Schizophrenia|
|Substance Abuse||Alcohol and Drug Use|
|Poor Physical Health||Disability|
|Personal Problems||Abusive Relationships|
|Genetics||Family History of Suicide|
Yet, the presence of one or more of these factors does not automatically lead to suicide. What causes a person to kill themselves? Why does ending one’s life make sense to an otherwise healthy young person?
A Scientific Explanation of Self-Destruction
Scientists have postulated the following theories to explain why someone chooses to end their life:
- The Werther Effect (suicide contagion) is named after Goethe’s The Sorrows of Young Werther and refers to how some people who read the book emulated the main character and took their own lives. This type of copycat suicide is prevalent among young people who develop an idealistic view of death.
- Mass suicide refers to a number of people ceding their will to live to the control of an individual who goads them into killing themselves. The most famous example of this type of suicide is the death of nearly 900 people at the Jonestown compound in Guyana (some people call this mass murder since many people were forced to kill themselves).
- Suicide bombings are an act of political murder carried out by individuals who believe their sacrifice is an honorable act of martyrdom (despite the fact that they kill thousands of innocent people in the process).
- Suicide clusters are similar to the Werther effect. They refer to a higher than usual number of suicides occurring in the same area within a short period of time. This type of self-harm is sometimes fueled by media coverage and overreporting of high-profile cases, making it appear like normal behavior to impressionable young people.
Sociologists believe a number of factors cause a person to take their life. More people than ever are living alone. There is a rise in the rate of chronic, debilitating diseases. Modern lifestyles do not allow for participation in organized religion and the support system it offers. High bankruptcy rates and skyrocketing healthcare costs are other driving forces.
Suicide continues to be poorly understood. Every person who has an addiction or depression does not necessarily kill themselves. Some people with neither substance abuse nor any history of depression suddenly end their life without warning.
The Interpersonal Theory:
Thomas Joiner, a professor at Florida State University, is one of the few researchers who have articulated theories on suicide. He says he wanted to better understand and explain “all suicides, at all times, in all cultures, across all conditions.”
Joiner believes that the overlapping of three separate factors creates the conditions that drive a person to kill themselves. The defining aspect of Joiner’s theory is that it moves away entirely from previous assumptions that suicide has to do with a combination of social, medical, and psychological factors.
Joiner’s theory employs a more general, and yet, a more personal understanding of the rationale for taking one’s life. The Interpersonal Theory of Suicide presents the view that anyone, regardless of age, gender, socioeconomic position, family history, or substance abuse problem can choose to willfully end their life. The three circles of Joiner’s theory include:
Joiner believes that most suicides are based on an intractable sense of loneliness or the inability to connect or belong. Divorced, single, or childless people are at a higher risk of suicide. This may explain why African-Americans and Hispanics exhibit lower rates of death by self-harm than white people because these communities typically have stronger familial and religious ties that preclude members from feeling alone despite any societal challenges they may face.
Losing a sense of purpose can be a precursor to harming one’s self. When a person stops being an asset to their community, to their friends and family, and to their employer, a relationship with death begins to take hold. Feelings of worthlessness, hopelessness, isolation, being a burden, being trapped, and not belonging may develop. Rather than relying on help from friends and loved ones, they choose to end their lives.
Suicide is not easy. Joiner believes that the final component of what would potentially lead to self-harm is the “courage” to go through with it rather than chicken out at the last moment. A familiarity with death and killing or even a desensitization to violence can push a person to the other side, making the act of killing just another turn of the screw. This explains why veterans are prone to taking their own life, given their combat experience and familiarity with firearms
Based on Joiner’s theory, preventing suicides does not seem like an impossible task. Any of these factors can be alleviated through simple steps such as joining a church or volunteering so that a festering sense of hopelessness does not infect the entire soul.
The theory explains how suicide, or the pre-conditions of it, are an easy trap into which anyone can fall. Therefore, the Interpersonal Theory is inclusive, stating that suicidal thoughts can encompass anyone who falls into any one of the above categories.
Joiner’s theory relates to people from all walks of life. It shows how previous notions of who is at highest risk for suicide – the mentally ill, addicts, the impoverished – do not always apply. Most importantly, it theorizes that suicide is not a marginal or abnormal behavior that happens only to those whose lives are perceived as being of no value.
Addiction and Suicide: An Undeniable Connection?
Researchers have been unable to determine exactly how much addiction contributes to suicide. According to one analysis published in the Archives of Suicide Research in 2009, approximately 20 to 60 percent of people who took their own lives had a preceding substance use disorder. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that suicide is the leading cause of death in people with addictions. People with alcohol dependence are at 10 times higher risk of suicide than those in the general population.
Alcohol Use and Suicide Plans in U.S. Students
Substance abuse, depression, and suicidal behavior are all interlinked. Who is at greatest risk of suicide? Traditionally, middle-aged white men have been at highest risk with a three times greater chance of taking their own life compared to women and people of other ages and racial groups. However, since the late 1990s, trends show an increase in the number of suicides among white women, Native Americans, and young girls between the ages of 10 and 14. African-Americans and Latinos do not exhibit the same suicide rates as white people despite the fact that these communities are often impoverished and have poor access to healthcare.
The UN Office on Drugs and Crime reports that 200,000 lives are lost in drug-related incidents each year. The CDC reports that more than 20 million Americans are struggling with a dependence on drugs or alcohol. It is possible then that increasing suicides and drug-related deaths are somehow interconnected?
Does Substance Abuse Increase Risk of Suicide?
Substance abuse affects many aspects of an addict’s life – personal, social, professional, financial, and medical. A life spiraling out of control can overwhelm a person and cause them to sink into depression with suicidal thoughts. In fact, research shows that suicidal thoughts, plans, and attempts are dramatically higher in individuals who have a substance use disorder and co-occurring mental illness.
Suicidal Thoughts and Substance Use
|Adults with Alcohol Use Disorder||10.7%|
|Adults with Substance Use Disorder||11.2%|
|Adults who use Illicit Drugs||16.4%|
|Adults with Substance Use and Co-Occurring Mental Illness||30.7%|
The connection between substance abuse and suicide is not as ironclad as more well-known risk factors of suicide such as social isolation and depression. Yet, recent studies have shown that this link is undeniable. Opioid abusers are 13 times more likely to contemplate and attempt suicide compared to the general public.
Experts have tried to understand the relationship between substance abuse, poverty, health, and suicide rates. Not everyone with alcohol or drug problems has suicidal thoughts. And not everyone who commits suicide is under the influence of illicit substances. Yet, addiction and suicide can contribute to each other with devastating consequences. Some of the questions that need to be answered include: Does poverty predispose to drug abuse or vice versa? Is a young addict at greater risk of taking their own life than someone who is impoverished, in poor health, or middle-aged? And most importantly, how can one tell if someone is contemplating ending their life?
What Puts Addicts at Risk of Suicide?
Substance abuse and mental illness often occur together. People with mental health problems are more likely to abuse drugs and alcohol or self-medicate. Many substances of abuse lead to mood problems such as anxiety and depression. During the early recovery period in addiction treatment, suicidal thoughts may occur due to mood disturbances arising from drug withdrawal.
Early recovery increases the risk of suicidal behavior because this is an incredibly stressful time for the addict. Recovering addicts are dealing with a host of emotions, including shame, guilt, isolation, hopelessness, self-hatred, and a sense of failure, all of which can lead to suicidal thoughts. Addiction relapse, financial problems, relationship troubles, or the loss of a loved one can trigger suicidal behavior in people with substance use disorders.
Drugs and alcohol alter the brain chemistry of addicts and disrupt the reward and pleasure systems. Individuals with addictions stop participating in previously enjoyable activities and seek artificial and immediate pleasure from illicit drugs. Alcohol intoxication is associated with lack of inhibition, increased impulsiveness, and failure to understand consequences. This makes it more likely for suicidal thoughts to progress into attempts under the influence of alcohol. In fact, impulsive suicide attempts (with less than 5 minutes of planning) are common in people with drug and alcohol problems.
Several studies have shown that people (especially teenagers and young adults) who are exposed to suicide in the home or community are more likely to develop suicidal behavior. In other words, if a loved one dies by suicide, it is a strong risk factor for similar behaviors. This puts family members of drug addicts with a history of suicide at increased risk. A prior suicide attempt is one of the strongest risk factors for repeat attempts in the future. Researchers have also studied the role of genetics in suicide and addiction. People with a family history of substance abuse, suicide, and depression are known to be more prone to suffer from these same conditions. However, more in-depth studies are needed to reach firm conclusions about the role of genetics in fatal self-harm.
Is My Loved One at Risk of Suicide?
Substance use disorders, depression, and suicidal behavior are all treatable. But, these conditions must first be recognized in a loved one so that the family can seek professional help. Drug rehabilitation facilities can provide treatment or referrals for suicidal ideation during the addiction recovery process.
Alcohol Use and Suicide Plans in U.S. Students
- Killing themselves
- Feeling hopeless
- No reason to live
- Feeling like a burden
- Feeling trapped
- Intractable pain
- Increased drug or alcohol use
- Searching online for ways to commit suicide
- Too much and too little sleep
- Withdrawal from family and friends
- Stopping previously enjoyable activities
- Saying goodbye to people
- Giving away possessions
- Anxiety and depression
- Irritability, aggression, agitation
- Loss of interest
- Mood swings
- Substance use disorders
- Depression and anxiety
- Bipolar disorder
- Traumatic brain injury
- Unbearable pain
- Serious health problems
- Access to drugs, chemicals, firearms
- Stress (relationships, profession)
- Suicide by a family member or TV news
- Previous suicide attempts
- Family history of suicide
- Trauma, neglect, or abuse in childhood
Family and friends should be aware of the signs and symptoms that a loved one may be contemplating suicide. There is also an urgent need to overcome the stigma attached to suicide and addiction which are often seen as easy, painless, cowardly, selfish, vengeful, or rash. Never ignore suicidal behavior. Even a person who appears positive and on the road to recovery from addiction can suddenly experience a suicidal crisis brought on by a stressful event. Seeking timely help is critical to saving a life. Screening programs for suicide are not foolproof. Even clinicians sometimes fail to recognize a person is at risk of ending their life. Given its inconspicuous nature and the shame associated with suicidal thoughts, it is not impossible for someone to fall through the cracks.
Helping Addicts with Suicidal Thoughts
Friends and family of substance abusers with suicidal thoughts and behavior can take several steps to prevent suicide and help in the recovery from addiction.
- Show love and care
- Be supportive and encouraging
- Be open and honest without judging
- Remove dangerous objects (chemicals and weapons) that could be used in an attempt to cause self-harm
- Ask the person if they are thinking of killing themselves
- Stay with the person until one can get help
- Call 1-800-273-TALK (8255) for guidance
- Call 911 if self-harm seems imminent
- Seek the help of mental health professionals
How to help someone in a suicidal crisis? A suicidal crisis in a person with a substance use disorders can pass as suddenly as it comes on. Therefore, the important thing is to keep the person safe with short-term risk management measures. Once the moment passes and the person has the opportunity to think more clearly, the crisis usually ends.
Addiction Treatment and Suicide Prevention
Research shows that concurrent treatment for a mental illness (such as depression) and substance use disorders is effective. There is limited evidence to show that the same is true for suicidal thoughts and addiction treatment. Usually, withdrawal from drugs and alcohol is associated with a decrease in depression. However, in some recovering addicts, depression may persist after drug rehab. If suicidal thoughts do not resolve after completing addiction treatment, it is vital to seek mental health counseling.
The good news is that studies show the risk of self-harm is less following addiction treatment. The chance of taking one’s life is less in addicts who have undergone rehabilitation. Yet, friends and family should be aware that stressful life situations can trigger both a relapse to drug or alcohol use and a relapse to suicidal thoughts. Professional drug rehab centers have professionals who are trained to address suicidal thoughts and behaviors during substance abuse treatment. Continued followup, aftercare, support, and love are crucial for the safety and wellbeing of recovering addicts.
If a loved one is struggling with an addiction or suicidal thoughts, know that help is available. Millions of people have successfully recovered from substance use disorders. A life without alcohol and drugs and a life that does not seem utterly hopeless is possible with treatment and faith.
Suicide Prevention Resources
A number of emergency services, including 24×7 hotlines, online forums, and professional help, are available to individuals in a suicidal crisis. Here are some tools, resources, and information sources for family and friends of anyone who may be contemplating ending their life:
- The National Suicide Prevention Helpline 1-800-273-TALK (8255) and suicidepreventionlifeline.org is operated by the National Institute of Mental Health and offers 24x7 online and telephone support from mental health professionals.
- Veterans Crisis Line 1-800-273-8255 (press 1), text 838255, or go online veteranscrisisline.net for around-the-clock help for veterans in crisis.
- The federally funded Suicide Prevention Resource Center provides assistance to professionals taking care of people with suicidal behavior.
- The Crisis Text Line is geared towards young people who can text HELP to 741-741 and be connected to someone.
- The Trevor Project at 1-866-488-7386 or thetrevorproject.org offers free, confidential help to LGBTQ individuals from trained professionals.
- The MY3 app lets people struggling with suicidal thoughts stay connected.
- American Foundation for Suicide Prevention undertakes advocacy efforts, education, and research on projects to help people affected by suicide.
- Suicide Awareness Voices of Education equips communities with information about mental illness and provides resources to end the stigma associated with suicide.