The relationship between addiction and suicide is a major driver in efforts, especially by friends and family members, to encourage people to go into recovery programs. There is plenty of overlap between substance use disorders and other risk factors for suicide, such as depression, anxiety, criminal behavior, and traumatic personal histories. Those seeking therapy may find themselves caught trying to disentangle a complex web of thoughts about suicide, addiction patterns and unresolved mental health or personal issues that drive them closer to ending their lives. Making it worse is that expressing concerns about either addiction or suicide alone is challenging, and social stigmas can feel even more difficult to overcome when attempting to cope with both.
Risk Factors for Suicide
Those trying to spot warning signs of trouble should keep an eye out for the major risk factors for suicide. These risk factors include:
- A family history of abuse, substance misuse or suicide
- Economic difficulties, particularly homelessness
- Mental illness, especially depression
- Lack of access to health care
- Loss of a job, relationship or friendship
- A history of consuming alcohol or using drugs
- Access to weapons
Some of the warning signs may look from the outside like someone is just going through a rough patch. Getting a drink after losing your job isn’t in itself a sign that you are going to commit suicide, after all. It is worth considering, however, that even if you think someone is just going through a rough patch, you should take time to talk with them and get a sense of how their emotional state is.
The Role of Substance Use
Regular use of substances, whether legal or illicit, tracks closely with the possibility that an individual might engage in suicidal ideation. The evidence of this is strong as reflected in a study that demonstrated that youth suicide rates were higher in regions that had lower minimum drinking ages for alcohol. More than 20 percent of all non-traffic deaths tied to alcohol appears to be suicide-related.
What is especially concerning is that the effects of substance use on the brain and on one’s emotions tend to nudge a number of people toward a state of mind that strongly correlates with taking their own lives. One study of heroin and methadone users, for example, showed that their brains appeared similar to those of much older individuals who had Alzheimer’s syndrome, which itself also a risk factor for trying to kill oneself.
The brain can also undergo an aggressive rewiring during repeated drug use, such as cocaine users often experience. This can lead to feelings of helplessness that kick in within 90 minutes of not getting another hit of the drug. Consequently, a cycle of anxiety and sleeplessness can kick in, creating a cycle of feedback that pushes an individual closer and closer to the brink.
It is also worth noting that many short-term swings in behavior can occur. For example, individuals using drugs or alcohol often experience major reductions in their inhibitions. Their appetite for and assessment of risk can also shift dramatically.
This is one of the reasons that the combination of a substance use disorder and access to a firearm or a vehicle can so quickly lead to lethal consequences. Simply put, while intoxicated, a person may just not see the awfulness of the decision the same way they would while sober. There is a part of the human brain that, even during a sobriety and when not distraught, can feel what is known as the “call of the void.” One can easily picture how such a moment could get out of hand during a time of reduced inhibitions.
The role that certain neuroreceptors play in how the human brain operates is often cited in regard to the progression of addiction. Dopamine, in particular, has earned a place in the pop culture lexicon for the role it plays in driving people to seek a sense of release through a variety of activities, including sex, video games, eating and, of course, drug and alcohol use. These types of neuroreceptors play a critical role in what is seen as reward-seeking behavior.
If someone does or gets something and it leads to feeling good, dopamine reinforces the sense that they should work hard to experience that feeling again. Unfortunately, the more the dopamine receptors are pounded with sensations, the harder it can be for the body to get the same kick from doing that thing. This, alongside developed tolerances for drugs, is one of the big factors in the cycle of people seeking bigger and bigger fixes as a product of addiction.
Many individuals who have been to therapy as a result of suicidal ideation or due to attempts to take their own lives have expressed a sense that life isn’t worth living. In cases involving those with substance use disorders, a major driver of this feeling may be the loss of reward that comes with needing to do more drugs in order to get the same positive sensations. Eventually, this can give rise to hopelessness in the face of the inability to get a fix from anything less than a lethal dosage. This also can make trying to disambiguate an overdose from a suicide attempt very tricky.
The Role of Mental Illness
The fact that people who are experiencing the effects of mental illness are twice as likely as the general population to have a substance use disorder is also a potential contributing factor in suicidal behavior. Individuals with depression symptoms are both more likely to consume drugs or alcohol and more likely to consider killing themselves. They have also been found to have 20 times the risk of a suicide attempt versus the rest of the population. Such risk factors grow even more dangerous in families with histories of mental illness.
It should be noted that addiction often appears alongside behaviors that are described as acts of self-medication. A study of lab rats with a specific genetic marker indicated that the rats with a unique protein deficiency were 50 percent more likely than others to prefer alcohol over water. Under observation, these rats were also shown to exhibit greater anxiety, and the alcohol appeared to have a self-medicating effect that led to a reduction in anxiety. This correlates closely with the stereotype of alcohol in humans as a social lubricant.
As is the case with many other risk factors involving addiction, this can lead to multiple diagnoses during the recovery process. For this reason, individuals who have indications of mental illness, whether untreated or diagnosed, may need to engage in more highly supervised programs. This could include inpatient care in a facility that has the resources and trained staff required to cope with suicide attempts.
Spotting the Warning Signs
Whether you are looking at your own life or you are wondering about someone else’s condition, it may be helpful to appreciate what some of the warning signs are. The more obvious indications of trouble include:
- A decline in hygiene
- A habit of wearing the same unwashed clothes on multiple days, especially at work or school
- Absences from school or work
- Changes in who the individual hangs out with
- Criminal conduct
- Irritability, particularly picking fights or starting arguments
- A noticeable drop in previous interests, such as hobbies and sports
On the flip side, some indicators may not be that easy to pick up. For example, a person struggling with addiction might display certain high-functioning behaviors, such as:
- Presenteeism, the habit of showing up to work or school in a poor condition
- Use of alcohol or drugs as a reward, such as partying at the end of the workweek
- Weight loss or gain
A common problem with suicidal ideation is that many people, especially those in families with histories of mental illness, have a tendency to dismiss it as melodramatic behavior. Someone may state something to the effect of:
- “No one would miss me if I were gone.”
- “I just don’t see the point in going on.”
- “I have no idea how I’ll get through this next week.”
Any of these statements, in isolation, might not be cause for much concern. On the other hand, if you know someone is coping with addiction already and experiencing other pressures, it might be prudent to have a talk about their emotional well-being. Don’t let the conversation go quickly; many people coping with the effects of addiction, suicidal thoughts and depression can be highly practiced at even dismissing the merits of their own feelings. Regardless of a person’s history, even if it might seem like they’re prone to melodrama about the possibility of suicide, it’s better to engage in a discussion out of an abundance of caution.
Support Is Important
Studies of people who have a chance to move forward from the dual challenges of addiction and contemplation of suicide show that they tend to do so because they have support from family members, friends or a larger community. If you’re personally trying to figure out what to do and you believe there’s absolutely no one to turn to, there are programs set up to assist individuals at high risk of addiction-related suicide.
Should you feel the time has come to look into recovery options, it is important to consider going into a program that handles those who have dual or multiple diagnoses. Plenty of people have been able to bounce back from substance use disorders on their own or while going through outpatient programs, but the heightened concern about addiction alongside suicidal thoughts makes it riskier to try to kick a habit without the support of professionals.
Be aware that detoxification from a number of substances, particularly alcohol and cocaine, does have the potential to be dangerous. Some of the drugs prescribed to help with the detox process, especially benzodiazepines or benzos, can themselves lead to substance abuse patterns. It’s often critical that the recovery process is conducted in a setting where emergency medical help is readily available. You’ll also likely feel greater confidence in the process while working with trained professionals who understand the link between suicide and addiction.
Recovery and therapy, especially when conducted together to deal with substance use disorder and mental health concerns, are both processes. For family members and friends, this means being caring and steady as well as providing support regardless of whether relapses might occur. The important thing is to stay focused on the goal of getting better. With a structured approach and a continuing commitment to kicking a habit, it is possible to create a brighter future.