Suicide and Substance Abuse

Suicide is the eighth-leading cause of death in the United States. Each year 29,000 people take their own lives. About 50 percent of all suicide attempts involve alcohol and illegal drugs (including those who use alcohol or drugs in their attempt or test positively for alcohol or drugs at the time of the attempt). About 25 percent of completed suicides occur among drug abusers and those with alcohol abuse problems. The suicide rate of people under age 30 is increasing, largely because of substance abuse among young adults.

Suicides among young people nationwide increased dramatically in recent years. Each year in the United States, thousands of teenagers commit suicide. Suicide is the third-leading cause of death for 15-to- 24-year-olds, and the sixth-leading cause of death for 5-to-14-year- olds. More than 50 percent of teens who commit suicide have a history of alcohol and drug use. Many teens who are considering suicide suffer from depression.

Suicides are not random. Each one occurs for particular reasons, such as depression or abuse of alcohol or drugs. Studying such high-risk groups is an important way to prevent suicides.

Researchers studying suicide try to discover what factors in a person's life contributed to his or her suicide. They interview the suicide victim's relatives, friends, and others and study the victim's medical records. They also consider suicide notes and coroner reports. Researchers then compare cases of completed suicide, cases of attempts at suicide, and cases of substance abusers who have never attempted suicide. The differences among these groups may help experts to identify those at particular risk of attempted or completed suicide.

Studies have shown that young adults who drink heavily have an increased risk of suicide in middle adulthood. People who are dependenton alcohol or drugs have an increased risk of death from accidents, disease, and suicide. In fact, suicide is among the most significant causes of death in both male and female substance abusers.

The strongest risk factors for attempted suicide in adults are depression, alcohol abuse, cocaine use, and separation or divorce. The strongest risk factors for attempted suicide in youth are depression, alcohol or other drug use disorder (including binge drinking and sub- stance abuse), and aggressive or disruptive behaviors. The frequency of suicide attempts among substance abusers is five times greater than the frequency among people who do not abuse substances. This is particularly true for alcoholics, because major depression is 50 percent more common among alcoholics than nonalcoholics. Many people drink alcohol or use drugs such as cocaine to reduce feelings of depression. However, drinking and drug use can actually lead to greater anxiety, depression, and thoughts of suicide. Many people recovering from heroin addiction make suicide attempts.

Another psychological disorder that increases the risk for suicide attempts is antisocial personality disorder (ASP). This disorder typically affects males who have a genetic predisposition for alcoholism. Many males with ASP also abuse drugs.

Drug abusers often have feelings of being unwell or unhappy. Although these feelings may not last long enough to qualify as major depression, they may nonetheless increase drug abusers' risk of attempting suicide. In addition, there is a relationship between injecting drugs and suicide attempts. Addicts who inject drugs are aware that they are engaging in high-risk behaviors and may be less concerned about their well-being overall. Alcoholics and drug addicts often lose their jobs and have troubled relationships. These problems increase their risk of making a suicide attempt.

The major risk factors for completed suicide among alcoholics are:(1) current drinking, (2) major depression, (3) suicidal thoughts, (4) loss of support from family and friends, (5) living alone, and (6) unemployment. Less is known about how these risk factors affect other substance abusers.

Depression and Other Psychiatric Conditions. Psychiatric conditions such as depression, schizophrenia, and ASP play an important role in the suicide of alcoholics and drug abusers. The vast majorityof suicide victims have symptoms of depression at the time of their death. At least 50 percent of alcoholics and drug abusers who commit suicide also had depression. Depression is just as likely to affect young people as adults.

Long-Term Use. Long-term substance use makes suicide more likely. Nearly all alcoholic suicides occur among active drinkers, and the person often drinks alcohol immediately before the suicide. An alcoholic who remains abstinent has a lower risk of suicide.

Major Life Disruption. The strongest indicator of suicide risk in sub- stance abusers is a major interpersonal loss such as separation or divorce. Among young people, parents' divorce, family violence, a breakup with a boyfriend or girlfriend, stress to perform and achieve, and school failure may trigger suicides. Many suicidal teens report feelings of inner turmoil, chaos, and low self-worth. Also, hopelessness and anger often contribute to adolescent suicide. Most of these problems are associated with both substance abuse and suicide. In other words, troubled or depressed young people may turn first to alcohol or drugs as a means of coping, and later attempt or commit suicide. Other personal problems a substance abuser may face are being un- employed, living alone, and/or lacking the support of family and friends at the time of this final and most severe upset. The individual's expectations of the future may also increase the risk of suicide. For example, a substance abuser may be worried that an overwhelming problem, such as legal or financial trouble, is about to happen. Alcoholics who develop serious medical problems, such as liver disease, pancreatitis, or peptic ulcers, are also at higher risk of suicide.

In the months prior to their suicides, substance abusers often see a doctor or are hospitalized for psychiatric problems. Those who talk of suicide may have mixed or confused feelings about their wish to die. Treating the substance abuse problems as well as the mental health problems of these individuals can help them to conquer their wish to die.

Predicting who will complete suicide remains difficult, even among high-risk groups such as substance abusers. Doctors and other health- care professionals often fail to recognize alcoholism and drug abuse in patients and the signs of depression that can lead to suicide. The substance abuser who has active suicide plans or has recently attempted suicide may need hospitalization, detoxification, or rehabilitation designed to encourage abstinence from alcohol and drugsof abuse. Firearms should be removed from the homes of substance abusers who talk about suicide, especially adolescents and young adults.

Making sure that a person at risk of suicide finds treatment for mental health and substance use problems, as well as increasing social support from family, friends, and health-care professionals, can reduce the risk of suicide.

In The Power to Prevent Suicide: A Guide for Teens Helping Teens (1994), authors Richard E. Nelson and Judith C. Galas share insight into the warning signs for suicide, and encourage young adults to reach out to their friends in danger. The book describes how a student can help other teenagers, and it lists organizations such as crisis centers as well.

Accidents and Injuries from Alcohol; Accidents and Injuries from Drugs; Users.

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