When you are addicted to drugs, alcohol or certain behaviours such as gambling, there undoubtedly exists a wide range of dangers to your physical and mental health. Drug and alcohol users are often concerned with the risk of overdose, and often overlook psychological-fuelled risks such as suicide. To correct this, we outline the dangers of underestimating the risk of suicide for those of us who have developed an addiction. We subsequently argue for the need for the assessment and treatment of suicidal ideation for those of us who are suffering from an addiction.
An overview of suicide in the United Kingdom
In the United Kingdom, suicide is the number one cause of death for males under the age of 35. In 2013-2014, 6,233 suicides occurred in the UK. There are around 11.9 suicide deaths per 100,000 population.
Globally, around 1 million people die each year by way of suicide. Around 40,000 of these deaths occur in the United States.
Compared to the general population, individuals treated for alcohol abuse or dependence are around 10 times more likely to commit suicide, and people who inject drugs are around 14 times more likely to commit suicide. A 2004 study found suicide is the leading cause of death among people who abuse alcohol and drugs. The study also found that acute alcohol intoxication is present in 30- 40% of suicide attempts/completed suicides.
For all suicide deaths, the figures released by the Office of National Statistics say you’re three times more likely to commit suicide if you are male. If you are male you are most likely to commit suicide between the age of 45-59. And the most common method of suicide is ‘hanging, strangulation and suffocation.’ However, when addiction is involved, women are more likely to commit suicide compared to their male peers. In 2014, 27% of all female suicides were linked to addiction, compared to just 15% of male suicides (see figures 1 & 2 below).
Figure 1: Male drug misuse deaths by underlying cause, deaths registered in 2014
Figure 2: Female drug misuse deaths by underlying cause, deaths registered in 2014
Problems that accompany addiction increasing the risk of suicide
It’s clearly no secret that addiction diminishes a person’s lifestyle and mental health. This ranges from social isolation right up to extreme traumatic events such as rape and sexual assault. Below we list a number of negative social, physical and psychological implications of addiction. Taken together, these problems help explain why suicide is prevalent for those suffering from addiction.
Here’s a list of negative factors that often accompany addiction:
- Social isolation
- Psychological instability e.g. shame, anger, fear, guilt and feeling their life is out of control
- Obsession with stimuli associated with addiction
- Getting in trouble with the law
- Negative vocational consequences
- Negative financial consequences
- Negative family consequences
- Sleeping disorders
- Weight loss
- Withdrawal symptoms
- Suicidal ideation
- Serious physical health concerns e.g. HIV, liver problems etc.
Chicken or the Egg? What comes first, addiction or mental health problems?
One must also understand that addiction may equally result from mental health problems as opposed the reverse. This is because many people ‘self-medicate’ with drugs, alcohol and certain behaviours in order to ‘block out’ the pain caused by mental health problems such as anxiety and depression.
However, we tend to agree with the lyrics to the 1997 song by The Verve, “the drugs don’t work, it just makes it worse.” Substance abuse typically antagonises and exacerbate mental health problems. Certainly, using drugs and alcohol is no cure for mental health problems. As the sufferer’s tolerance to the substance increases, a greater quantity of the substance is required in order to ‘block out’ negative thoughts and feelings associated with the mental health problem. Eventually, substances will no longer work and the suicide threat becomes greater than ever.
Suicidal risks for people living in recovery
Even those who have defeated addiction remain at a heightened risk of committing suicide when compared to the rest of the population. This is because it may take many years for the brain to restore to its pre-addiction state. Negatives symptoms experienced by former addicts are known as ‘post-acute’ withdrawal symptoms. These symptoms range from depression, anxiety and continued cravings.
Here’s a list of ‘post-acute’ withdrawal symptoms:
- Continued cravings for the addiction substance/behaviour
- Mental health problems e.g. depression, anxiety etc
- Trauma & grief
- Cognitive distortions
These symptoms are particularly great when the recovered addict first returns home following a stint in a treatment centre. Returning home can be a scary experience for the recovered addict, and a time when social isolation and depression may occur. Many of the former addict’s friends and associates may be current drug users, and the recovered addict will aim to avoid these people.
However, this avoidance could result in total social isolation since this person does not know any ‘non-using’ friends. This social isolation could trigger severe depression and suicide ideation. It’s thus essential for treatment centres to ensure their clients are well integrated back into society following the completion of treatment.
Other factors that increase the risk of suicide
The evidence demonstrates that suicide is often the caused by many complex and overlapping factors, with addiction being one of the more prevalent factors. Below we list a number of additional suicide risk factors you should be aware of.
Here’s a list of additional non-addiction suicide risk factors:
- Previous suicide attempts
- Co-occurring mental health problems
- Victim of rape or sexual assault
- Deliberate self-harm
- Legal problems
- Social isolation
- Recent divorce or separation
- A history of childhood abuse
- Low self-esteem & self-loathing
Recognising suicidal ideation
If your loved one is addicted to drugs/alcohol or certain behaviours, we urge you to be on the lookout for the signs of suicide. The most common warning sign is the person expressing a wish to ‘end it all’. This person may be open about how he or she plans to carry out the suicide. If this is the case, we urge you read the information below detailing each step you must take to try to avoid your loved one committing suicide.
Now we now list a number of suicide ‘warning signs’ you really should be aware of:
- Communicating an intent to commit suicide
- Active preparation for suicide
- Spending too much time alone
- Loss of interest in hobbies
- Abusing substances
- Expressing negative emotions such as hopelessness, grief and depression
- Pessimistic about the future
- Mood swings
How to help someone to avoid suicide
If you believe your loved one is preparing his or her suicide, you will probably be seeking out strategies that will help him or her overcome these suicidal tendencies. First off, we recommend you confront your loved one regarding his or her intent to commit suicide. If your suspicion is confirmed, we recommend you ask your loved one if he or she has taken any steps to attempt suicide yet.
If you follow this approach, it’s essential you adopt the role of a good listener. Ensure your empathy is apparent. During this phase, you are essentially information gathering. Once you’ve built up a good pictures of your loved one’s problems, it’s now important to recruit the help of other family members and close friends. You may also reach out to adult social services or other relevant agencies for professional support.
It’s highly likely the person will require professional treatment. This treatment typically takes place on a residential basis, where the sufferer will live within a professional caring environment for around 4-12 weeks. During this time, your loved one will receive a number of therapies designed to tackle substance abuse and co-occurring mental health problems, including treatment for suicidal ideation.
Once the person has overcome his or her addiction and suicidal ideation, it’s essential you frequently check in on their progress for at least another 12 months, because suicidal ideation is known to rebound following treatment. Ensure you visit your loved one regularly, as well as making frequent telephone check-ins.
Specific addictions and suicide
We now outline the risk factors associated with a number of addictions. This includes an addiction to alcohol, cannabis, opiates and cocaine.
1. Alcohol and suicide
Alcohol is perhaps the most well-known drug that’s associated with suicide. Alcohol addiction causes a number of negative conditions in the sufferer’s lifestyle. These conditions cause a number of mental health problems such as depress and anxiety that significantly increase the risk of suicide. Around 1/3 of people who commit suicide are acutely intoxicated with alcohol.
2. Cocaine and suicide
A recent study demonstrated a strong link between mixing cocaine/alcohol and suicidal ideation. The study examined 874 cases of attempted suicide treated at US hospitals. The data shows when alcohol is mixed with cocaine, there’s a corresponding increased risk of the user attempting suicide.
3. Cannabis and suicide
Unfortunately, there exists a link between long-term cannabis use and suicide. This is mainly because cannabis is known to antagonise existing mental health problems such as anxiety and depression. Long-term cannabis use is known to cause psychosis. Furthermore, cannabis use may also decrease the quality of the sufferer’s lifestyle by causing money, relationships and career problems. Thus, cannabis may indirectly increase the risk of suicide.
4. Heroin and suicide
There exists a powerful link between heroin use and suicide. Heroin use depreciates every aspect of the user’s lifestyle including finances, relationships, job prospects and mental outlook. Many heroin addicts complain of experiencing feelings of ‘hopelessness’ and despair. Many of these people thus express their desire to commit suicide.
Heroin use may also cause a number of physical health problems such as HIV and hepatitis. All of these consequences of heroin use may lead to a deterioration in the user’s mental health and a corresponding increase in the risk of the user committing suicide.
Studies show heroin addicts are particularly at risk of committing suicide when attempting to detox from the drug. Detoxing from heroin results in painful withdrawal symptoms. Many people undergoing an unsupervised heroin detox may decide to commit suicide as a way to avoid these unbearable withdrawal symptoms.
- Suicide Anonymous
- NHS information on suicide
- Prevention of young suicide
- Suicide Prevention in Scotland
Posted on Tuesday, May 31st, 2016 at 4:17 pm in Mental Health.