Anyone who cares about an addict has a long list of concerns, not the least of which is that addiction may take their loved one’s life. Mostly we fear getting word of a serious accident or injury or perhaps a drug overdose. What few think about, or actively work to prevent, is suicide. And while suicide is a well-known risk for those suffering from mental health problems, it also requires attention in the assessment and treatment of addiction.
Suicide is the 10th leading cause of death in the U.S. 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. In fact, 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.
Substance abuse not only increases the likelihood that a person will take their own life, but it is also used as a means for committing suicide. Roughly one in three people who die from suicide are under the influence of drugs, typically opiates such as oxycodone or heroin, or alcohol. Poisoning is the third-leading method used in suicide deaths, and drugs make up 75 percent of suicide deaths due to poisoning.
When Hope Runs Out
Why is suicide the tragic fate of so many people struggling with addiction? There are a few possible explanations. Under the influence of drugs or alcohol, people may lose inhibitions and take risks they ordinarily would not. Additionally, many people abuse drugs or alcohol in an attempt to relieve the symptoms of depression, anxiety, or other mental health conditions. The rate of major depression is two to four times higher among addicts than in the general population.
Although drugs may seem to help in the short term, they exacerbate problems over time. When attempting to stop using drugs, people may feel overwhelmed by the return of painful emotions that they had been medicating with drugs. They may also be clear-headed enough to carry out suicidal thoughts and plans. Transitions, such as entering or leaving treatment, relapse, and death, divorce, or other major life changes, can be especially vulnerable times.
Abusing drugs, especially depressants such as alcohol or sedatives, can also trigger symptoms of depression, increasing the risk of suicide. As the consequences of addiction pile up, from legal problems and damaged relationships to financial ruin and job loss, individuals may lose all hope that things can get better. For some, it starts to seem like there are only two paths to relief: spiraling back into drug use or death.
Prevention Begins with Treatment
Scientific studies have explored the close link between addiction and suicide. So why is the risk of suicide so often overlooked?
Although the suicide rate among patients with untreated substance use disorders is reportedly as high as 45 percent, only 11 percent of addicts get treatment. Stigma plays a role in keeping people from getting help, and lack of training in suicide prevention contributes to the problem once people do seek treatment.
Primary care physicians are positioned to help identify and prevent suicidality, but only if they know what to look for and how to create an effective suicide prevention plan. Unfortunately, few of us have been trained to do this. As a result, many shy away from asking about and addressing suicidal ideation even when the patient is struggling or has in the past struggled with addiction, depression, or other mental health disorders.
Someone has to ask the difficult questions about whether the patient has ever considered or attempted suicide and whether they currently think about or intend to commit suicide. Someone needs to let the patient know that they are not alone, that they are cared for and that hope remains, and then collaborate with them and their loved ones to create a recovery plan that first ensures their safety and then addresses the underlying issues. Who better to do this than a trusted health care provider?
Research shows that certain populations that commit suicide, including older adults and women, are likely to have seen a primary care provider in the year before their death. Thus, improving our ability to recognize and treat the factors that lead to suicide can go a long way in helping to prevent it.
We know the very serious threats facing patients with addictions and mental health disorders. 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.
We worry about the addicts in our lives for good reason. 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.