The Connection Between Suicide, Alcohol and Substance Use Disorders

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By Brian Thorn, Esq., Chief Operating Officer, Pinnacle Treatment Centers

Each year, mental health providers and advocates, in collaboration with local, state, and federal agencies, spend the month of September working to raise awareness about suicide in the U.S.

In 2019, we designate the week beginning Sunday, September 8th as National Suicide Prevention Week. We also join our colleagues around the world to bring an even sharper focus to suicide awareness by recognizing Tuesday, September 10th as World Suicide Prevention Day

This article will offer the latest facts and figures about suicide in the U.S. and around the world, discuss the relationship between suicide and alcohol/substance use disorders, and share ideas about how members of the general public can help raise awareness about suicide during National Suicide Prevention Month.

Suicide Rates: U.S. and the World

The Centers for Disease Control (CDC) identify suicide as a serious public health problem. Doctors and scientists at the American Foundation for Suicide Prevention go further: they consider suicide a national public health crisis. Regardless of the label – serious problem or national crisis – the latest suicide statistics are alarming not only for public health professionals, but for everyone.

Data from the CDC for the U.S. shows:

  • 45,000 people died by suicide in 2016.
  • Suicide rates have increased 33% since 1999.
  • Suicide now ranks as the 10th leading cause of death.
  • More people die by suicide than in motor vehicle crashes each year.
  • Suicide is the 2nd leading cause of death among people age 10-34.

In addition, the World Health Organization (WHO) reports the following global suicide statistics:

  • Almost 800,000 people die by suicide every year – that’s one person every 40 seconds.
  • Suicide is the second leading cause of death for people, age 15-29, after road/automobile-related injury.
    • For women age 15-29, suicide is the second leading cause of death, after complications surrounding maternity and/or childbirth.
    • For men age 15-29, suicide is the third leading cause of death, after road/automobile-related injury and interpersonal violence.

We spend our time and energy during the month of September raising awareness about suicide because the total numbers are greater than most people realize. There’s also another reason – possibly more important – why we think it’s critical to raise awareness about suicide:

In many cases, suicide is preventable.

We’ll discuss ways you can join the suicide awareness and prevention movement in a moment. First, we’ll address the relationship between suicide and alcohol/substance use disorders.

The Connection Between Suicide and Alcohol/Substance Use Disorders

In recent years, behavioral and public health scientists have increased the volume of research related to suicide risk among individuals living with alcohol and substance use disorders (AUD and SUD).

In identifying possible suicide risk factors for which primary care and behavioral health care providers should screen, researchers at the Substance Abuse and Mental Health Service Administration (SAMHSA) report the following key facts:

  • People with an AUD have risk of suicide 10 times greater than those without an AUD.
  • Those who misuse illicit drugs have a risk of suicide 14 times greater than people who don’t.
  • Individuals with an AUD/SUD and a mental health disorder have a risk of suicide nine times greater than those with a substance use disorder alone.

Treatment providers, whether in behavioral health, addiction treatment, or general practice, need to understand these statistics and the very real risks they represent for their patients. But they’re not the only ones who need to pay close attention to these numbers: the general public needs this knowledge, as well. People with friends, colleagues, family members, or loved ones living with an alcohol and/or substance use disorder should understand that those loved ones – in addition to living with the difficult emotions related to addiction – are also at increased risk of suicide.

This foregrounds the ongoing imperative to reduce stigma around addiction, specifically, and mental health disorders in general. We can replace that stigma with the awareness that people living with these disorders need our help, and that treatment – the earlier the better – can help them manage their symptoms, live full lives, and reduce the risk of untimely death related to suicide or overdose.

Unfortunately, there’s more data to examine about the relationship of suicide and alcohol/substance use disorders – and it supports the importance of our awareness and prevention efforts.

The 2015 National Survey on Drug Use and Health (NSDUH)

After an in-depth analysis of the 2015 National Survey on Drug Use and Health (NSDUH), SAMSHSA researchers identified new trends among Americans with SUDs and suicide risk.

The NSDUH survey is compiled from interviews of Americans ages 12 or older and designed to be representative of the entire population. The analysis of suicide risk and SUDs focused strictly on adults 18 or older. It’s important to note that the predictions of suicide risk and SUDs based on the NSDUH may underestimate risk, because homeless persons as well as those currently institutionalized were not interviewed.

In determining suicide risk, interview questions asked about alcohol use, illicit drug use, or the presence of a SUD within a year prior to 2015.

Here’s what they found:

  • Women who use illicit drugs were at greater risk of suicide than men, which is a deviation from national trends that find men are four times more likely to commit suicide than women.
  • Among adults who misused alcohol, illicit drugs, both, or reported a substance use disorder, thoughts of suicide, conscious plans of suicide, and suicide attempts all increased.
  • Adults with co-occurring mental disorders, such as major depression or bipolar disorder, were at the highest risk of suicide.
  • Heavy drinkers are five times more at risk of suicide than social drinkers.
  • A higher suicide risk among those abusing opioids during the past decade – a period when national opioid abuse doubled.

This set of facts allows us to identify and prioritize those members in our community who are at the highest risk: women who use illicit drugs, men and women who misuse multiple drugs, adults with an AUD/SUD and a co-occurring mental disorder, heavy drinkers, and those diagnosed with opioid use disorder (OUD).

A Public Health Response: What Providers Can Do

Given these alarming statistics and findings, we recognize the importance of targeted interventions for reducing suicide risk in these vulnerable populations.

As health care providers, we understand we can work to better integrate treatment plans for patients who present risk factors such as substance misuse, depression, or difficulty regulating emotion. SUDs involve multiple levels of distress and dysfunction, including biological, behavioral, and cultural dimensions. Therefore, treatment plans should include multiple interventions:

  • Pharmacological (i.e. methadone or buprenorphine for opioid use disorder)
  • Psychotherapeutic (individual and group)
  • Family crisis plans (i.e. monitoring family members discharged from hospitals with opioid medications)
  • Community-oriented campaigns to promote addiction education, awareness, wellness and stress reduction
  • Ongoing support after treatment (i.e. aftercare plans, alumni support services)

Successful public health campaigns – created with the direct involvement of the treatment community – can help reduce suicide risk by recognizing and addressing the important links between AUDs, SUDs, and other emotional, behavioral, and mood disorders. Efforts to promote collaboration among a variety of health care providers is crucial in addressing the phenomenon of co-occurrence and the complexity of suicide risk – now more than ever.

What You Can Do

As a member of the general public, you’re already taking the first step: raising your own awareness about suicide and learning about the connection between suicide and alcohol and/or substance use disorders.

In recognition of National Suicide Prevention Month, we’ll conclude this article by returning our focus to suicide. There are several things you can do to help raise awareness about the disturbing increase in suicide over the past two decades.

Education is first, as mentioned: you’re reading this article. Also, to better understand the role of recovery in addiction and mental health disorders, please read this recent article by Pinnacle Treatment Centers CEO, Joe Pritchard: “National Recovery Month: Join the Voices of Recovery – Together We Are Stronger”.

Next, you can learn the warning signs of suicide. This list – provided by the National Alliance on Mental Illness (NAMI) – includes some, but not all, of the warning signs people planning suicide might display:

  • Increased alcohol or drug use
  • Increased aggression
  • Withdrawal from friends or family
  • Extreme mood swings
  • Stockpiling medication
  • Purchasing a weapon
  • Giving away possessions
  • Saying goodbye to friends and family
  • Getting affairs in order: paying debts, closing accounts, writing wills

Please Note: This article cannot diagnose suicide risk. If you think someone is at imminent risk of suicide, call 911 immediately. Do not wait. Always err on the side of caution.

You can also visit the website #BeThe1To and learn about the Five Action Steps – all evidence-based and proven effective – that you can take if you think someone you know is contemplating suicide. We offer the five steps here in their most basic form.

Suicide Prevention: Five Action Steps

  1. Ask the direct question: “Are you planning to commit suicide?” Research shows simply asking this can reduce suicide attempts.
  2. Keep them safe until the immediate crisis has passed, or they’re under the supervision of medical professionals.
  3. Be there for them physically (see #2), emotionally, and psychologically. A sense of connectedness to the world and others reduces suicide risk.
  4. Help them connect to professional resources. SHARE THIS NUMBER: The National Suicide Prevention Lifeline (24/7/365): 1-800-273-8255. These hotlines work, and the professionals who answer the line can help at-risk individuals through crisis moments.
  5. Follow up with calls, texts, IMs, or in-person visits. Sometimes what an at-risk person needs most is the knowledge that someone cares enough to reach out and make sure they’re okay, whether it’s a friend, family member, or co-worker.

For complete details on how to implement these action steps and further participate in National Suicide Awareness Month and World Suicide Prevention Day, click here.

We’ll close with a reminder that friends, family, and community play a vitally important role in the lives of those experiencing thoughts of suicide. We’re not exaggerating, fabricating, or going out on a limb by saying that. In fact, the latest research and data about suicide support the idea summed up perfectly by this simple sentence:

One phone call can save a life.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.