Substance abuse doesn’t sit in a neat little package, tied up with a bow, waiting for treatment. Instead, imagine this little box...with octopus tentacles coming out of it. That’s addiction: It may start as overuse of a substance, but then it spreads to all areas of an addict’s life–family, career, and the way an addict sees him or herself in the world. One area to which addiction spreads is the addict’s concept of self-worth. As we’ve known (and as you probably could have guessed), addiction increases suicide risk.

An article just published in the Journal of Affective Disorders looks inside this overall risk to discover what it is, exactly, inside addiction that puts people at risk for suicide. The study interviewed patients at a drug abuse treatment center and found that 68 percent of patients had major depressive disorder; 28 percent had attempted suicide within the last year. Here are the characteristics that predicted which patients had attempted suicide:

1. Alcohol/Marijuana as First-Used Drugs

Patients who dove into heroin or methamphetamines were less likely to be suicidal than patients who had started with alcohol or marijuana. Also, suicide risk was highest when people who started with alcohol moved to marijuana and when people who started with marijuana moved on to cocaine. The researchers suggest that perhaps people who start with alcohol or marijuana may also be most likely to use these substances (as opposed to others) in the attempt to self-medicate for depression, or as a result of depression, and that it is this association with depression and not characteristics alcohol/marijuana themselves that push suicide risk past that of other drugs.

2. Depression Before Addiction

Depression is a risk factor for substance abuse. When depression comes first, addiction also comes with increased suicide risk. When substance abuse acts like a symptom of depression, it is essential to treat the underlying cause of depression along with the addiction.

3. Suicide Before Addiction

This finding is fairly intuitive: Patients who had attempted suicide before becoming addicted were also more likely to attempt suicide during addiction.

4. Family Drug Abuse History

Addicts who came from families that included addicts were at higher risk for depression and for suicide attempts. But why? Is it because growing up in an environment that included an addicted family member might not have provided the kindest childhoods for patients in the study? Or is it due to a genetic component of addiction and/or depression in which an addicted family member meant that patients in this study were more likely to have genes that predispose them to addiction and depression, and thus suicide?

All these factors taken together seem to mean that a person’s history before becoming addicted is as important as the addiction itself in predicting major depression and suicide attempts. This underscores the need to treat depression and other conditions along with addiction–addiction may be one of many symptoms of an underlying condition. Addiction certainly doesn’t help a person prone to depression avoid suicide attempts, but treating the addiction by itself may leave tentacles of depression or other co-occurring conditions–these tentacles may be the factors putting addicts most at risk for suicide.  

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Richard Taite is founder and CEO of Cliffside Malibu, offering evidence-based, individualized addiction treatment based on the Stages of Change model. He is also co-author with Constance Scharff of the book Ending Addiction for Good.

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