This article is designed to raise awareness surrounding this co-morbidity in addiction and mental health. If you are struggling, please don’t suffer thinking there is no hope. You can find contact information for charities, groups and organisations who can help at the bottom of this article.
Suicide & Substance Abuse
Considered one of the nation’s greatest health epidemics by many in the medical and mental health fields, suicide is one of the top leading causes of death in the United Kingdom, along with the consequences that addiction can cause, such as overdosing, especially among young people.
The suicide rate of 11.2 deaths per 100,000 population recorded by the Office for National Statistics (ONS) in 2018 is an increase on the 10.1 per 100,000 population recorded in 2017, which was the lowest since the organisation began recording data on suicide in the United Kingdom in 1981. This in collaboration with The Samaritans.
Suicide, addiction and depression have a very close and interconnected relationship. More than 90% of people who fall victim to suicide suffer from depression, have a substance use disorder (drug and alcohol addiction), or both.
Depression and substance use combine to form a vicious cycle that can lead to suicide in certain cases. Many who experience such severe depression (as a result of Major Depression, Bipolar Disorder, Obsessive Compulsive Disorder, Borderline Personality Disorder and other conditions) frequently turn to drugs, alcohol, gambling and other risky behaviours to numb their physical or mental pain and/or alleviate their negative feelings that can arise during addiction and mental health conditions.
However, substance use and addiction actually increase the severity and duration of depressive episodes, despite any temporary relief they may provide, actually greatly increasing the likelihood of suicidal thoughts (suicidal ideation).
This is exacerbated by the fact that addiction frequently damages or destroys familial, professional, personal and financial relationships, further increasing the risk of suicide. Even worse, many substances severely impact judgment, leading to suicide attempts.
- Close to 800 000 people die due to suicide every year
- For every suicide there are many more people who attempt suicide every year. A prior suicide attempt is the single most important risk factor for suicide in the general population
- Suicide is the third leading cause of death in 15-19-year-olds
- 79% of global suicides occur in low- and middle-income countries
- Ingestion of pesticides, hangings, overdoses and firearms are among the most common methods of suicide globally
- Members of the LGBTQ+ community are also at an increased risk of self harm and suicide
Every year close to 800 000 people take their own life and there are many more people who attempt suicide. Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind. Suicide occurs throughout the lifespan and was the second leading cause of death among 15-29 year-olds globally in 2016.
Suicide does not just occur in high-income countries, but is a global phenomenon in all regions of the world. In fact, over 79% of global suicides occurred in low- and middle-income countries in 2016.
Suicide is a serious public health problem; however, suicides are preventable with timely, evidence-based and often low-cost interventions. For national responses to be effective, a comprehensive multisectoral suicide prevention strategy is needed.
Methods Of Suicide
It is estimated that around 20% of global suicides are due to pesticide self-poisoning, most of which occur in rural agricultural areas in low- and middle-income countries. Other common methods of suicide worldwide are hangings, overdoses and firearms.
Knowledge of the most commonly used suicide methods is important to devise prevention strategies which have shown to be effective, such as restriction of access to means of suicide.
Prevention & Control
Suicides are preventable. There are a number of measures that can be taken at population, sub-population and individual levels to prevent suicide and suicide attempts.
- Reducing access to the means of suicide (e.g. pesticides, firearms, certain medications)
- Reporting by media in a responsible way
- School/education-based interventions
- Introducing sensible, realistic and workable drug and alcohol policies to reduce the harmful use of drugs and alcohol
- Early identification, treatment and care of people with mental and substance use disorders, chronic pain and acute emotional distress
- Training of non-specialised health workers in the assessment and management of suicidal behaviours
- Follow-up care for people who attempted suicide and provision of community support.
- Grater public awareness of both suicide and substance addiction
- Easier access to mental health and addiction treatment services
Suicide is a complex issue and therefore suicide prevention efforts require coordination and collaboration among multiple sectors of society, including the health sector and other sectors such as education, labour, agriculture, business, justice, law, defense, politics and the media.
These efforts must be comprehensive and integrated as no single approach alone can make an impact on an issue as complex as suicide and addiction.
Challenges & Obstacles
Stigma & Taboo
Stigma, particularly surrounding mental health disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need.
The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it.
To date, only a few countries have included suicide prevention among their health priorities and only 38 countries report having a national suicide prevention strategy.
Raising community awareness and breaking down the taboo is important for countries to make progress in preventing suicide.
Members of the LGBTQ+ communities are also at an increased risk of suicide and self harm.
Globally, the availability and quality of data on suicide, suicide attempts and surrounding addiction is poor. Only 80 Member States have good-quality vital registration data that can be used directly to estimate suicide rates.
This problem of poor-quality mortality data is not unique to suicide, but given the sensitivity of suicide and the illegality of suicidal behaviours in some countries, it is likely that under-reporting and misclassification are greater problems for suicide than for most other causes of death.
Improved surveillance and monitoring of suicide and suicide attempts is required for effective suicide prevention strategies. Cross-national differences in the patterns of suicide, and changes in the rates, characteristics and methods of suicide, highlight the need for each country to improve the comprehensiveness, quality and timeliness of their suicide-related data.
This includes vital registration of suicide, hospital-based registries of suicide attempts and nationally-representative surveys collecting information about self-reported suicide attempts.
Causes of Suicide
Every case of suicide is dramatically different, as are the causes surrounding it. In most cases, there is no single cause, but rather a large number of contributing factors which then end up leading to the unfortunate end result.
Some of the most common risk factors for suicide can include, but not limited to:
- Suicidal thoughts
- Previous suicide attempts
- Hallucinations, side effects or complications caused by mental health conditions
- Drug and alcohol abuse
- Family/community history of suicide
- Family history of violence and/or sexual abuse
- Previous/current jail time
- Presence of firearms/weapons in the home
- Violent behaviour/abuse toward others
- Irregular use of mental health medication, off use or use of someone else’s medication
- Chemical/medication imbalance
- Homophobia, transphobia, racism ect
- Lack of ambition or satisfaction in their life
- Debts or financial burdens
- Loss of employment or lack of employment
- Chronic family distress or abuse
- Sexual, mental, financial, physical or any other type of abuse
- Parent/child separations
- Divorce or civil marriage dissolution
- And others
Of all the factors associated with suicide, only depression (66% of people who fall victim to suicide are dealing with depression or mental health condition at the time) is more closely correlated than substance use.
Did you know:
Individuals with a substance use disorder are nearly six times as likely to attempt suicide at some point in their life.
Among veterans (ex armed forces personnel), men with a substance use disorder are more than twice as likely to fall victim to suicide, and women with a substance abuse disorder are 6.5 times as likely to fall victim to suicide.
Opioids & Suicide
Of all addictions, perhaps none is more likely to result in suicide than opioid addiction. In 2015, over 33,000 Americans died from opioids. Due to the nature of overdose, it is impossible to know how many of these deaths were accidental and how many were suicides. Men with an opioid use disorder were twice as likely to fall victim to suicide and women with an opioid use disorder were eight times as likely to fall victim to suicide.
Opioid use is associated with a 40%-60% increased likelihood of suicidal thought and a 75% increased likelihood of suicide attempt. Some studies suggest that opioid and injection drug users are 13 times as likely to die by suicide.
Suicide Warning Signs
Every person who contemplates suicide is dramatically different, as are the warning signs they exhibit and the length of time they show the warning signs before actually attempting suicide.
Some exhibit many “classic” warning signs for a long period of time before falling victim to suicide and some exhibit essentially no warning signs publicly. It is very rare that any one person will exhibit a full range of warning signs, and many who exhibit warning signs never attempt, much less fall victim to suicide.
The most common warning signs for suicide include:
- Expressing a desire for death
- Expressing a feeling of being trapped, hemmed in or with no way out
- Acting agitated or anxious
- Reckless/irresponsible behaviours
- Isolation from friends, family, work or other commitments or responsibilities
- Avoiding social situations
- Abandoning hobbies, interests or other sources of enjoyment
- Wanting to hide away, often in dark rooms or locations
- Heavy drug and alcohol use
- Extreme irritability
- Sudden decrease in work or academic performance
- Writing letters or notes
- Internet searches about suicide or how to commit suicide
- Lack of pride in appearance or personal hygiene
- Collating medication, ropes, maps of high locations such as railway bridges or cliff tops or other preplanning/preparation
- Updating or creating a will or funeral arrangements unexpectedly
- Changes in the individual’s behaviours, attitudes, outlooks on life or other negative comments such as “don’t worry, I don’t bother you for much longer” or “I’ll be out of your way soon”
- Evidence of self harm, such as cutting, burning, overdoses or others
Those Left Behind
Because of the assumption that suicide is a choice, many who are left behind feel that they could have done something to stop it, should have noticed the warning signs sooner or that it’s their fault that the individual didn’t want to stay alive for. This leaves an overwhelming sense of guilt and self-blame in addition to loss of that person, which is often left unsatisfied because they cannot get reassurance from the individual that it wasn’t their fault or that they weren’t worth enough to stay alive for. This then leaves feelings of emptiness and further guilt, shame, embarrassment, anger or other negative feelings or thoughts.
In certain cases, it may cause such a devastating response in those left behind that they then may also consider suicide as a way to escape the pain and emptiness that they feel.
Of all the possible ways to lose a loved one, many find suicide to be one of the most painful.
It is important to know that if you have lost someone to suicide, it was NOT your fault. Any decisions they made were entirely their own and you hold no responsibility for their actions.
However, if you suspect someone you love might be contemplating suicide, it is equally important to get them help immediately. Luckily, there are many organisations dedicated to the prevention of suicide and countless resources available to you. Many of these options are free. In general, immediate help, treatment and therapy should be sought for anyone experiencing suicidal thoughts or ideations.
Because substance abuse so greatly increases the risk of suicide, one of the most critical steps in suicide prevention is overcoming any addictions and getting sober. This will alleviate the depression and related mental health symptoms of the individual who is experiencing suicidal thoughts, and improve their short-term judgment. It will also allow mental health professionals to more accurately assess and diagnose any underlying mental health concerns so that they can be properly treated.
Addressing The Co-morbidity Of Substance Use & Suicidal Ideations
Considering suicide or self harm within individuals care plans should be a standard policy across the full spectrum of individuals who attend their GP surgery, community based drug and alcohol service, residential rehabilitation facility, Prisons, Police stations, Probation services, mental health services or any other type of interpersonal services where the persons well being can be regularly monitored and set protocols initiated if any warning signs or “red flags” are identified, so that the individual can receive the very best standard of care and treatment at the absolute earliest opportunity before it’s too late and suicide attempts are attempted or at worst, succeed.
Examples of bad care can include the two examples below.:
- An male who has attempted suicide is treated for the injuries sustained from jumping off a high building. No assessment of their involvement with drug or alcohol use is conducted; no further referral for assessment or treatment of a potential drug or alcohol use disorder is done – despite the fact that he was clearly in a state of alcohol intoxication at the time the event occurred. He has also attended prior meetings with the smell of alcohol on his breath while in meetings with his key worker at 9:30am on three separate occasions.
- Another person is offered continuous, ongoing treatment with methadone for their addiction and physical dependence to opioids. Her prior suicide attempts are not considered in her treatment plans for opioid dependence, even though her wrists show the tell-tale signs of continued self harm via cutting, injecting and burning.
How Do We Ensure That We Also Consider Substance Use When We Treat People With Suicidal Ideations/Behaviours, And Likewise, Consider Suicidal Behaviours When Treating People With Substance Use Disorders?
This question was at the heart of the discussion on Substance Use and Suicide in the International Context when global experts met at WHO headquarters in Geneva on 19–21 October 2015 to study the interplay between substance use and suicide.
Suicide is an important cause of death and disability worldwide, with the larger share of suicide deaths in absolute numbers occurring in low and middle-income countries.
One modifiable risk factor for suicide, especially relevant for young people at risk, is alcohol and drug use. WHO Member States have committed to the global target of reducing suicide rates by 10% by 2020.
Achieving the target requires countries to take several actions including reducing risk factors like substance use. They are supported by WHO’s Mental Health Gap Action Programme (mhGAP) which provides evidence-based technical guidance to expand services on priority conditions such as self-harm, suicide and substance use disorders.
Participants of the global meeting reviewed and discussed the complex relationship between substance use and suicidal behaviours, as well as possible programmes and interventions, with examples from more than 10 countries.
The group concluded that important gaps remain in the estimates of suicide deaths associated with substance use and substance use disorders, particularly due to cannabis, amphetamine and cocaine use.
They also established that there are important gaps in information about the role of intoxication by various drugs on suicide attempts.
Substance use was the cause of 175 000 out of the 800 000 suicides worldwide in 2012 – at least one in five. Interventions that address concurrent suicidal behaviour and substance use should be implemented and evaluated to support professionals in ensuring that hundreds of thousands of people who suffer from both disorders are well cared for.
If you or a loved one are having thoughts of suicide, it is imperative that you seek help immediately.
If you are experiencing suicidal thoughts and need support, you can:
- Call your GP and ask for an emergency appointment
- Call NHS 111 (England) or NHS Direct (Wales) for out-of-hours to help
- Contact your mental health crisis team if you have one
- Phone a free 24/7 free helpline such as Samaritans (info below) or others
You can find contact information for groups, charities and organisations who can provide help and support for all of those involved on our help and support page here.
You can find links to organisations, charities and groups who provide free resources about suicide on our downloads and media page here. These include those who feel suicidal, friends and family, healthcare professionals, the general public and government.
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